Abstract 14035: Effects of Intensive Antihypertensive Therapy in Type 2 Diabetic Patients With or Without Baseline Mild or Moderate Chronic Kidney Disease
Background: Aggressive antihypertensive therapy has long been recommended in patients with chronic kidney disease (CKD) and diabetes mellitus. In the main Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, however, no significant benefits were observed with intensive (systolic blood pressure goal <120 mm Hg) as compared to standard (systolic blood pressure goal <140 mm Hg) antihypertensive therapy in high-risk patient with type 2 diabetes mellitus. In this analysis, we investigated the impact of these goals in ACCORD participants with or without CKD.
Methods: 2,952 (63.1%) of 4,678 participants in the ACCORD blood pressure trial were free of CKD at baseline, while 1726 (36.9%) had CKD 1-3 (693 (14.8%) Stage 1 CKD (eGFR ≥90, but with albuminuria), 632 (13.5%) Stage 2 CKD (eGFR 60-89), and 401 (8.6%) Stage 3 CKD (eGFR 30-59). Patients were randomized to intensive or standard antihypertensive therapy. The primary outcome was a composite of nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death; several prespecified secondary outcomes were also assessed.
Results: In patients with CKD the primary end point occurred in 2.79% of patients in the intensive group and 3.19% in the standard group (hazard ratio:0.860;CI 0.667-1.108). There were no significant differences in any of the secondary outcomes. Similarly, there were no statistically significant differences in the primary outcome between the two groups of therapy in patients without CKD. However, in pts without CKD, intensive antihypertensive therapy resulted in significant reduction of both non-fatal stroke (hazard ratio: 0.50; 95% CI: 0.250-0.993, p-value for CKD by treatment interaction: 0.57 ) and any stroke (hazard ratio: 0.45; 95% CI: 0.22-0.88 value for CKD by treatment interaction p= 0.44).
Conclusions: These exploratory subgroup analyses suggest that intensive antihypertensive therapy does not offer significant benefits in diabetics with mild to CKD
- © 2013 by American Heart Association, Inc.