Intensive systolic blood pressure lowering did not significantly increase the risk of major adverse kidney events compared to standard lowering (HR 1.35; 95% CI 0.85-2.14; P=0.20).
RCT (n=1,966)
Does intensive systolic blood pressure lowering (<120 mmHg) reduce major adverse kidney outcomes in adults with type 2 diabetes mellitus and cardiovascular risk factors?
Intensive systolic blood pressure lowering (<120 mmHg) does not significantly increase the risk of major adverse kidney events compared to standard lowering (<140 mmHg) in patients with type 2 diabetes and cardiovascular risk factors.
Effect estimate: HR 1.35 (95% CI 0.85-2.14)
Absolute Event Rate: 9.5% vs 7.2%
p-value: p=0.20
OBJECTIVE: To determine the effects of intensive systolic blood pressure (SBP) lowering on the risk of major adverse kidney outcomes in people with type 2 diabetes mellitus (T2DM) and/or prediabetes and cardiovascular risk factors. RESEARCH DESIGN AND METHODS: This post hoc ACCORD-BP subgroup analysis included participants in the standard glucose-lowering arm with cardiovascular risk factors required for SPRINT eligibility. Cox proportional hazards regression models compared the hazard for the composite of dialysis, kidney transplant, sustained estimated glomerular filtration rate (eGFR) 3.3 mg/dL, or a sustained eGFR decline ≥57% between the intensive (<120 mmHg) and standard (<140 mmHg) SBP-lowering arms. RESULTS: The study cohort included 1,966 SPRINT-eligible ACCORD-BP participants (40% women) with a mean age of 63 years. The mean SBP achieved after randomization was 120 ± 14 and 134 ± 15 mmHg in the intensive and standard arms, respectively. The kidney composite outcome occurred at a rate of 9.5 and 7.2 events per 1,000 person-years in the intensive and standard BP arms (hazard ratio HR 1.35 95% CI 0.85-2.14; P = 0.20). Intensive SBP lowering did not affect the risk of moderately (HR 0.96 95% CI 0.76-1.20) or severely (HR 0.92 95% CI 0.66-1.28) increased albuminuria. Including SPRINT participants with prediabetes in the cohort did not change the overall results. CONCLUSIONS: This post hoc subgroup analysis suggests that intensive SBP lowering does not increase the risk of major adverse kidney events in individuals with T2DM and cardiovascular risk factors.
Tawfik et al. (Tue,) conducted a rct in Type 2 diabetes mellitus and/or prediabetes with cardiovascular risk factors (n=1,966). Intensive systolic blood pressure lowering vs. Standard systolic blood pressure lowering (<140 mmHg) was evaluated on Composite of dialysis, kidney transplant, sustained eGFR <15 mL/min/1.73 m2, serum creatinine >3.3 mg/dL, or a sustained eGFR decline ≥57% (HR 1.35, 95% CI 0.85-2.14, p=0.20). Intensive systolic blood pressure lowering did not significantly increase the risk of major adverse kidney events compared to standard lowering (HR 1.35; 95% CI 0.85-2.14; P=0.20).