Beddhu S, et al. - In people with and without type 2 diabetes, researchers assessed the impact of intensive systolic blood pressure control on incident chronic kidney disease. Findings revealed that in people with and without type 2 diabetes, intensive lowering of systolic blood pressure increased the risk of incident chronic kidney disease, but in people with type 2 diabetes, the absolute risk of incident chronic kidney disease was higher. Particularly in adults with diabetes, physicians need to be vigilant in monitoring kidney function while administering intensive antihypertensive drug treatment.

Methods

• In individuals without diabetes, the Systolic Blood Pressure Intervention Trial (SPRINT) studied the impacts of a systolic blood pressure goal of less than 120 mm Hg (intensive intervention) vs a goal of less than 140 mm Hg (standard intervention).
• In people with type 2 diabetes, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure trial assessed a similar systolic blood pressure intervention.
• This investigation was a secondary analysis of limited access datasets from SPRINT and the ACCORD trial obtained from the National Institutes of Health.
• In patients without chronic kidney disease at baseline (n=4.311 in the ACCORD trial; n=6.715 in SPRINT), researchers compared systolic blood pressure interventions (intensive vs standard) to incident chronic kidney disease (defined as > 30% decrease in estimated glomerular filtration rate [eGFR] to <60 mL/min per 1.73 m²).

Results

• According to the findings, the average difference in systolic blood pressure when comparing intensive and standard interventions was 13.9 mm Hg (95% CI 13.4–14.4) in the ACCORD trial and 15.2 mm Hg (14.8–15.6) in SPRINT.
• Results revealed that the cumulative incidence of chronic kidney disease in the ACCORD trial was 10.0% (95% CI 8.8–11.4) with the intensive intervention and 4.1% (3.3–5.1) with the standard intervention (absolute risk difference 5.9%, 95% CI 4.3–7.5) at 3 years.
• It was noted that corresponding values in SPRINT were 3.5% (95% CI 2.9–4.2) and 1.0% (0.7–1.4; absolute risk difference 2.5%, 95% CI 1.8–3.2).
• The study results showed that the absolute risk difference was significantly higher in the ACCORD trial than in SPRINT (p=0.0001 for interaction).