Key result
Good response to RAAS inhibition linked to ~49% fewer CV events versus poor response.
Why the study?
Variability in systolic blood pressure and albuminuria responses to RAAS inhibition in type 2 diabetes and its association with cardiovascular outcomes was unclear.
Does a good response to RAAS inhibition (reductions in both SBP and UACR) predict a lower risk of cardiovascular events compared to a poor response in patients with type 2 diabetes?
Cohort (n=1,600)
Yes
Does a good response to RAAS inhibition (reductions in both SBP and UACR) predict a lower risk of cardiovascular events compared to a poor response in patients with type 2 diabetes?
In patients with type 2 diabetes, individual variability in SBP and UACR response to RAAS inhibition is large, and a good response (reductions in both) is associated with a significantly lower risk of subsequent cardiovascular events compared to a poor response.
Answers are grounded in this paper and cite their sources.
May support response-based CV risk stratification in T2D; leaves open whether guiding therapy by response improves outcomes.
AIMS: To assess variability in systolic blood pressure (SBP) and albuminuria (urinary albumin creatinine ratio [UACR]) responses in patients with type 2 diabetes mellitus initiating renin angiotensin aldosterone system (RAAS) inhibition, and to assess the association of response variability with cardiovascular outcomes. MATERIAL AND METHODS: We performed an observational cohort study in patients with type 2 diabetes who started RAAS inhibition between 2007 and 2013 (n = 1600). Patients were identified from general practices in the Netherlands. Individual response in SBP and UACR was assessed during 15 months' follow-up. Patients were categorized as: good responders (∆SBP <0 mm Hg and ∆UACR <0%); intermediate responders (∆SBP <0 mm Hg and ∆UACR >0% or ∆SBP >0 mm Hg and ∆UACR <0%); or poor responders (∆SBP >0 mm Hg and ∆UACR >0%). Multivariable Cox regression was performed to test the association between initial RAAS inhibition response and subsequent cardiovascular outcomes. RESULTS: After starting RAAS inhibition, the mean SBP change was -13.2 mm Hg and the median UACR was -36.6%, with large between-individual variability, both in SBP [5th to 95th percentile: 48.5-20] and UACR [5th to 95th percentile: -87.6 to 171.4]. In all, 812 patients (51%) were good responders, 353 (22%) had a good SBP but poor UACR response, 268 (17%) had a good UACR but poor SBP response, and 167 patients (10%) were poor responders. Good responders had a lower risk of cardiovascular events than poor responders (hazard ratio 0.51, 95% confidence interval 0.30-0.86; P = .012). CONCLUSIONS: SBP and UACR response after RAAS inhibition initiation varied between and within individual patients with type 2 diabetes treated in primary care. Poor responders had the highest risk of cardiovascular events, therefore, more efforts are needed to develop personalized treatment plans for these patients.
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Apperloo et al. (2018) conducted a cohort in Type 2 diabetes mellitus (n=1,600). Good response to RAAS inhibition (∆SBP <0 mm Hg and ∆UACR <0%) vs. Poor responders (∆SBP >0 mm Hg and ∆UACR >0%) was evaluated on Cardiovascular events (HR 0.51, 95% CI 0.30-0.86, p=.012). Good responders to RAAS inhibition had a lower risk of cardiovascular events compared to poor responders.
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