番茄社区

CHICAGO -- Intensive blood pressure (BP) treatment doesn't prevent kidney damage in patients with type 2 diabetes and may even hurt renal outcomes, researchers said here.

Diabetes patients on standard glycemic control reached mean systolic BP of 120.8 after a year of intensive treatment (target <120 mm Hg) compared with 134.6 mm Hg on standard treatment (goal <140 mm Hg), according to a of the ACCORD-BP trial presented by Ling Wang, MS, PhD, and colleagues at Michigan State University in East Lansing.

By then, according to their poster at the Joint Hypertension 2018 Scientific Sessions of the American Heart Association and the American Society of Hypertension, renal outcomes were largely similar between intensive and standard BP groups with one exception that disfavored the more aggressive strategy:

• Doubling of serum creatinine or >20 mL/min decrease in estimated glomerular filtration rate (eGFR): 59.2% versus 44.9% (P<0.0001)
• Urine albumin ≥300 mg/dL: 6.3% versus 6.9% (P=0.57)
• Renal failure or end-stage renal disease (dialysis) or serum creatinine >3.3 mg/dL: 2.5% for both (P=1.0)
• Urine albumin ≥30 mg/dL: 14.1% versus 15.3% (P=0.31)

"Consistent with our using SPRINT data from non-diabetic patients, this study provides evidence against the notion that intensive BP treatment leads to beneficial renal outcomes in diabetic patients," the investigators concluded.

However, it is “very common” that when BP is lowered in people with kidney disease, creatinine rises by 20%-30%, commented George Bakris, MD, director of the University of Chicago Medical Center’s Comprehensive Hypertension Center. “This has mistakenly been interpreted as acute kidney injury when it is nothing more than kidney adapting to a lower BP.”

Patients showed partial or total return in kidney function toward baseline over a period of a month or two. “This has been observed in many studies and unfortunately, many physicians fear they have caused injury and in the majority of cases over 90% they have not,” he told 番茄社区.

Randomized trials have shown that BP goals <130/80 mm Hg don’t slow down kidney disease progression, but it would be inaccurate to say that these targets are hurting patients because the definition of acute kidney injury is a >50% increase in serum creatinine that is sustained over a period of time, Bakris emphasized.

For their study, Wang and colleagues included the 2,362 diabetes patients randomized to intensive or standard systolic BP treatment in ACCORD-BP. The two groups were comparable at baseline. Overall, mean patient age was 62.8; baseline BP averaged 139.4/76.0 mm Hg and 53% of participants were women.

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