Abstract P128: Intensive Blood Pressure Treatment and Renal Outcomes in Diabetic Patients

Abstract

Background: There is no certain evidence to support a strategy of lowering systolic blood pressure in persons with type 2 diabetes. We conducted a post-hoc analysis on the data set from Action to Control Cardiovascular Risk in Diabetes blood pressure trial (ACCORD-BP) to test the hypothesis that intensive blood pressure treatment prevents or alleviates adverse renal outcomes among diabetic patients. Methods: Patients were randomly assigned to a systolic blood pressure (SBP) treatment target of <120 (intensive treatment) or <140 (standard treatment). To rule out the effect of glycemic treatment, we only included patients with standard glycemic control (glycated hemoglobin of 7.0-7.9%) that resulted in 1,184 patients on intensive arm and 1,178 patients on standard arm. Four renal outcomes at the end of the study are considered: 1) Doubling of serum creatinine (SCr) or >20 mL/min decrease in eGFR; 2) UAlb>=300; 3) Renal failure or End-Stage Renal Disease (dialysis) or SCr>3.3; 4) UAlb>=30. Generalized Estimating Equation method is employed. Results: After 1 year, the mean SBP was 120.8 in intensive group and 134.6 in standard group. SCr doubling or >20 mL/min decrease in eGFR attributed to intensive treatment occurred in 701 of the 1184 participants in the intensive-therapy group (57.0%) and 529 of the 1178 participants in the standard-therapy group (44.9%) (OR=1.83, 95% CI= 1.76-1.90). We further categorized BP over time into three tiers, by low (SBP<120 and DBP <70), medium (SBP=120-140 and DBP=70-85) and high (SBP>140 and DBP>85). Both high SBP (>140) and medium SBP (120-140) as compared to low SBP (<120) level, significantly reduced the chance of serum creatinine doubling or >20 ml/min decrease in eGFR (OR=0.79, p<0.0001). There are no significant differences in other three renal outcomes between intensive and standard group patients. Conclusion: In patients with type 2 diabetes, targeting a systolic blood pressure of less than 120, as compared with less than 140, increased the chance of having Scr doubling or >20 mL/min decrease in eGFR. These results, consistent with our previous study using SPRINT data from non-diabetic patients, provide evidence against the notion that intensive blood pressure treatment leads to beneficial renal outcomes in diabetic patients.