P 7: Does choice of antidiabetic and/or antihypertensive treatment influence progression of nephropathy in hypertensive type 2 diabetic patients?

Abstract

It is well known that coexistence of arterial hypertension and type 2 diabetes significantly multiply cardio-renal risks. But the question remains – is it enough to strictly control blood glucose and blood pressure no matter how? Is the choice of treatment also important? So, the aim of this study was to assess the influence of the choice of antidiabetic and/or antihypertensive treatment on the rate of nephropathy progression in hypertensive type 2 diabetic patients, during long-term follow-up period. The study included 126 (62 female/64male) hypertensive type 2 diabetic patients (mean age: 50.45+5.61 years; duration of diabetes: 10.03+4.91 years and duration of hypertension: 11.32+5.38 years). Patients were assigned to antidiabetic and antihypertensive treatment aiming to attain pre-defined level of glycaemic (HbA1c < 7%) and blood pressure control (<130/85 mmHg). Nephropathy progression parameters, average annual increment of microalbuminuria (Δ UAE) and deterioration of glomerular filtration rate (Δ GFR), were prospectively followed-up for a mean period of 6.28 (0.88) years. Statistical analysis was performed using the STATISTICA 4.5 program (StatSoft, Tulsa, OK, USA). The significance of differences was evaluated using the Kruskal-Wallis test. A value of p<0.05 was accepted as statistically significant. A total of 62 (49.2%) patients achieved good glycaemic control while tight blood pressure control was achieved and maintained in 76 (60.3%) patients. Choice of antidiabetic treatment did not significantly influence the quality of glycaemic control (P=0.4233), while choice of antihypertensive drugs significantly influenced the quality of achieved blood pressure control (P=0.0357), speaking in favor of ACEI. Choice of antidiabetic treatment did not significantly influence the rate of microalbuminuria progression as well as the rate of deterioration of glomerular filtration both in patients with good (P=0.641 and P=0.837, respectively) and those with poor glycaemic control (P=0.305 and P=0.256, respectively). However, choice of antihypertensive treatment significantly influenced the rate of microalbuminuria progression (P=0.011) as well as the rate of deterioration of glomerular filtration (P=0.0013), but only in those with tight blood pressure control. Independently from the quality of achieved glycaemic control, choice of the antidiabetic treatment did not significantly influence the rate of nephropathy progression in hypertensive type 2 diabetic patients. However, choice of antihypertensive treatment significantly influenced the rate of progression of microalbuminuria and the rate of deterioration of glomerular filtration but only in those patients in whom good control of blood pressure was achieved.