Blood Pressure and Pulse Pressure Effects on Renal Outcomes in the Veterans Affairs Diabetes Trial (VADT)
Blood Pressure and Pulse Pressure Effects on Renal Outcomes in the Veterans Affairs Diabetes Trial (VADT)
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DOI：
10.2337/dc14-0284
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发表时间：
2014-10-01
期刊：
影响因子：
16.2
通讯作者：
Duckworth, William C.
中科院分区：
文献类型：
--
作者：
Anderson, Robert J.;Bahn, Gideon D.;Duckworth, William C.
目的控制血压（BP）以保护肾脏对于 2 型糖尿病患者至关重要。我们对退伍军人事务部糖尿病试验 (VADT) 数据进行分析的目的是了解研究中的收缩压 (SBP)、舒张压 (DBP) 和脉压 (PP) 是否影响以白蛋白肌酐比 (ACR) 和估计肾小球滤过率 (eGFR) 衡量的肾脏结果。 研究设计和方法 VADT 是一项前瞻性、随机研究，纳入了 1,791 名受试者患有 2 型糖尿病的退伍军人，以确定强化血糖控制是否可以预防主要心血管事件。在这项事后研究中，使用时变协变量生存分析和风险比 (HR) 来确定肾脏结局恶化。 结果与 SBP 105-129 mmHg 相比，SBP 130-139 mmHg 的 ACR 恶化风险显着增加（HR 1.88 [95% CI 1.28-2.77]；P = 0.001）和 SBP >= 140 毫米汞柱（2.51 [1.66-3.78]；P < 0.0001）。与 40-49 mmHg 的 PP 范围相比，PP < 40 与 ACR 恶化的风险显着降低相关（0.36 [0.15-0.87]；P = 0.022），PP >= 60 与风险显着增加相关（2.38 [1.58-3.59]；P < 0.0001）。对与 eGFR 恶化相关的血压范围的分析显示，基线 SBP 升高的风险显着增加，并且 SBP >= 140 mmHg 与研究中 A1C 之间存在交互作用。与 SBP = 130 mmHg 和 PP > 60 mmHg 的患者相比，这些患者与 ACR 恶化相关的可能性高出 15%。结果表明，治疗 SBP 至 = 140 mmHg 和 A1C 表明，高血压患者的血糖控制对减缓肾病进展的效果可能更大。
OBJECTIVEBlood pressure (BP) control for renal protection is essential for patients with type 2 diabetes. Our objective in this analysis of Veterans Affairs Diabetes Trial (VADT) data was to learn whether on-study systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) affected renal outcomes measured as albumin-to-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR).RESEARCH DESIGN AND METHODSThe VADT was a prospective, randomized study of 1,791 veterans with type 2 diabetes to determine whether intensive glucose control prevented major cardiovascular events. In this post hoc study, time-varying covariate survival analyses and hazard ratios (HR) were used to determine worsening of renal outcomes.RESULTSCompared with SBP 105-129 mmHg, the risk of ACR worsening increased significantly for SBP 130-139 mmHg (HR 1.88 [95% CI 1.28-2.77]; P = 0.001) and for SBP >= 140 mmHg (2.51 [1.66-3.78]; P < 0.0001). Compared with a PP range of 40-49 mmHg, PP < 40 was associated with significantly lowered risk of worsening ACR (0.36 [0.15-0.87]; P = 0.022) and PP >= 60 with significantly increased risk (2.38 [1.58-3.59]; P < 0.0001). Analyses of BP ranges associated with eGFR worsening showed significantly increased risk with rising baseline SBP and an interaction effect between SBP >= 140 mmHg and on-study A1C. These patients were 15% more likely than those with SBP = 130 mmHg and PP >60 mmHg were associated with worsening ACR. The results suggest that treatment of SBP to = 140 mmHg and A1C suggests that the effect of glycemic control on reducing progression of renal disease may be greater in hypertensive patients.