Effects of Intensive Systolic Blood Pressure Lowering on End-Stage Kidney Disease and Kidney Function Decline in Adults with Type 2 Diabetes Mellitus and Cardiovascular Risk Factors: A Post-hoc Analysis of ACCORD-BP and SPRINT

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 eGFR <15 ml/min/1·73 m2, serum creatinine >3·3 mg/dL, or a sustained eGFR decline ≥57%, between the intensive (<120 mm Hg) and standard (<140 mm Hg) 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 mm Hg and 134 ± 15 mm Hg in the intensive and standard arms, respectively. The kidney composite outcome occurred at a rate of 9.5 events and 7·2 events per 1,000 person-years in the intensive and standard BP arms (HR [95% CI]: 1·35 [0·85-2.14]; P = 0·20). Intensive SBP lowering did not have an effect on the risk of moderately (HR [95% CI]: 0·96 [0·76-1·20]) or severely (HR [95% CI]: 0·92 [0·66-1·28]) increased albuminuria. Including SPRINT participants with prediabetes in the cohort did not change the overall results.

Conclusion: 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.