Cardiovascular Outcomes in Action to Control Cardiovascular Risk in Diabetes: Impact of Blood Pressure Level and Presence of Kidney Disease

Abstract

Background: Persons with chronic kidney disease (CKD) represent a population prone to cardiovascular disease (CVD) but vulnerable to adverse medication effects. We assessed the impact of intensive antihypertensive therapy on the cerebrovascular and other CVD outcomes in high-risk patients with type 2 diabetes and baseline CKD. Methods: Using current guideline criteria, 1,726 (36.9%) of 4,678 participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure (BP) arm had mild to moderate CKD (CKD1-3B) at baseline. Participants of this study were randomized to intensive (systolic <120 mm Hg) or standard (systolic <140 mm Hg) BP goals. Fatal and non-fatal stroke were pre-specified secondary outcomes of the ACCORD study. Results: Total cerebrovascular events were significantly higher in participants with baseline CKD (0.66%/year) compared with participants free of CKD (0.28%/year). A significantly higher rate of events was observed in CKD participants. Intensive antihypertensive therapy in participants without CKD at baseline resulted in a 55% significant reduction of any stroke (hazard ratio 0.447; 95% CI 0.227-0.880) and a 50% reduction of non-fatal stroke (hazard ratio 0.498; 95% CI 0.250-0.993). In participants with CKD at baseline, the occurrence of any stroke was reduced by 38% (hazard ratio 0.623; 95% CI 0.361-1.074) and non-fatal stroke by 36% (hazard ratio 0.642; 95% CI 0.361-1.142). Test for interaction was NS between the 2 groups. Changes in other CVD outcomes did not reach statistical significance. Conclusions: These findings suggest that intensive antihypertensive therapy offers significant cerebrovascular protection in diabetic participants without CKD at baseline, but significant benefit to patients with CKD cannot be excluded.

Journal

Journal ID (publisher-id): AJN

Journal ID (nlm-ta): Am J Nephrol

Journal ID (doi): 10.1159/issn.0250-8095

Title: American Journal of Nephrology

Abbreviated Title: Am J Nephrol

Publisher: S. Karger AG (Basel, Switzerland karger@ 123456karger.com http://www.karger.com )

ISSN (Print): 0250-8095

ISSN (Electronic): 1421-9670

Publication date (Print): June 2016

Publication date (Electronic): 29 April 2016

Volume: 43

Issue: 4

Pages: 271-280

Affiliations

^aDepartment of Veterans Affairs Medical Center and ^bGeorgetown University School of Medicine, Washington, D.C., ^cDepartment of Veterans Affairs Medical Center, George Washington University, Washington, D.C., ^dWake Forest School of Medicine, Winston-Salem, N.C., ^eWFUHS Geriatric/Gerontology, Winston-Salem, Ohio, ^fUniversity of North Carolina, Chapel Hill, N.C., and ^gDepartment of Veterans Affairs Medical Center, VA Clinical Center Network, Memphis, Tenn., USA; ^hMcMaster Medical Center, Hamilton, Ont., Canada

Article

Publisher ID: AJN2016043004271 Other ID: Am J Nephrol 2016;43:271-280

DOI: 10.1159/000446122

PubMed ID: 27161620

Copyright statement: © 2016 S. Karger AG, Basel

License:

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Page count

Figures: 3, Tables: 3, References: 24, Pages: 10

Product

Self URI (journal page): http://www.karger.com/tap/Home/271371

Self URI: http://www.karger.com?doi=10.1159/000446122

Categories

Subject: Original Report: Patient-Oriented, Translational Research