American Diabetes Association
Supplemental Material DCare_clean 2022DEC23[AU].pdf (244.95 kB)

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

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posted on 2023-02-15, 01:30 authored by Yahya M.K. Tawfik, Benjamin W. Van Tassell, Dave L Dixon, William L. Baker, John Fanikos


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.


U.S. Department of Health and Human Services > National Institutes of Health > National Heart, Lung, and Blood Institute K23HL150311


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