Association between blood pressure and adverse renal events in type 1 diabetes

Elaine Ku, Charles E. McCulloch, Michael Mauer, Stephen E. Gitelman, Barbara A. Grimes, Chi Yuan Hsu

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

OBJECTIVE To compare different blood pressure (BP) levels in their associationwith the risk of renal outcomes in type 1 diabetes and to determine whether an intensive glycemic control strategy modifies this association. RESEARCH DESIGN AND METHODS We included 1,441 participants with type 1 diabetes between the ages of 13 and 39 years who had previously been randomized to receive intensive versus conventional glycemic control in the Diabetes Control and Complications Trial (DCCT). The exposures of interest were time-updated systolic BP (SBP) and diastolic BP (DBP) categories. Outcomes included macroalbuminuria (>300 mg/24 h) or stage III chronic kidney disease (CKD) (sustained estimated glomerular filtration rate <60 mL/min/1.73 m2). RESULTS During a median follow-up time of 24 years, there were 84 cases of stage III CKD and 169 cases of macroalbuminuria. In adjusted models, SBP in the <120 mmHg range was associated with a 0.59 times higher risk of macroalbuminuria (95% CI 0.37-0.95) and a 0.32 times higher risk of stage III CKD (95% CI 0.14-0.75) compared with SBPs between 130 and 140 mmHg. DBP in the <70 mmHg range were associated with a 0.73 times higher risk of macroalbuminuria (95% CI 0.44-1.18) and a 0.47 times higher risk of stage III CKD (95% CI 0.21-1.05) compared with DBPs between 80 and 90 mmHg. No interaction was noted between BP and prior DCCT-assigned glycemic control strategy (all P > 0.05). CONCLUSIONS A lower BP (<120/70 mmHg) was associated with a substantially lower risk of adverse renal outcomes, regardless of the prior assigned glycemic control strategy. Interventional trials may be useful to help determine whether the currently recommended BP target of 140/90 mmHg may be too high for optimal renal protection in type 1 diabetes.

Original languageEnglish (US)
Pages (from-to)2218-2224
Number of pages7
JournalDiabetes Care
Volume39
Issue number12
DOIs
StatePublished - Jan 1 2016

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Type 1 Diabetes Mellitus
Blood Pressure
Kidney
Diabetes Complications
Glomerular Filtration Rate
Chronic Renal Insufficiency

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Ku, E., McCulloch, C. E., Mauer, M., Gitelman, S. E., Grimes, B. A., & Hsu, C. Y. (2016). Association between blood pressure and adverse renal events in type 1 diabetes. Diabetes Care, 39(12), 2218-2224. https://doi.org/10.2337/dc16-0857

Association between blood pressure and adverse renal events in type 1 diabetes. / Ku, Elaine; McCulloch, Charles E.; Mauer, Michael; Gitelman, Stephen E.; Grimes, Barbara A.; Hsu, Chi Yuan.

In: Diabetes Care, Vol. 39, No. 12, 01.01.2016, p. 2218-2224.

Research output: Contribution to journalArticle

Ku, E, McCulloch, CE, Mauer, M, Gitelman, SE, Grimes, BA & Hsu, CY 2016, 'Association between blood pressure and adverse renal events in type 1 diabetes' Diabetes Care, vol. 39, no. 12, pp. 2218-2224. https://doi.org/10.2337/dc16-0857
Ku, Elaine ; McCulloch, Charles E. ; Mauer, Michael ; Gitelman, Stephen E. ; Grimes, Barbara A. ; Hsu, Chi Yuan. / Association between blood pressure and adverse renal events in type 1 diabetes. In: Diabetes Care. 2016 ; Vol. 39, No. 12. pp. 2218-2224.
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abstract = "OBJECTIVE To compare different blood pressure (BP) levels in their associationwith the risk of renal outcomes in type 1 diabetes and to determine whether an intensive glycemic control strategy modifies this association. RESEARCH DESIGN AND METHODS We included 1,441 participants with type 1 diabetes between the ages of 13 and 39 years who had previously been randomized to receive intensive versus conventional glycemic control in the Diabetes Control and Complications Trial (DCCT). The exposures of interest were time-updated systolic BP (SBP) and diastolic BP (DBP) categories. Outcomes included macroalbuminuria (>300 mg/24 h) or stage III chronic kidney disease (CKD) (sustained estimated glomerular filtration rate <60 mL/min/1.73 m2). RESULTS During a median follow-up time of 24 years, there were 84 cases of stage III CKD and 169 cases of macroalbuminuria. In adjusted models, SBP in the <120 mmHg range was associated with a 0.59 times higher risk of macroalbuminuria (95{\%} CI 0.37-0.95) and a 0.32 times higher risk of stage III CKD (95{\%} CI 0.14-0.75) compared with SBPs between 130 and 140 mmHg. DBP in the <70 mmHg range were associated with a 0.73 times higher risk of macroalbuminuria (95{\%} CI 0.44-1.18) and a 0.47 times higher risk of stage III CKD (95{\%} CI 0.21-1.05) compared with DBPs between 80 and 90 mmHg. No interaction was noted between BP and prior DCCT-assigned glycemic control strategy (all P > 0.05). CONCLUSIONS A lower BP (<120/70 mmHg) was associated with a substantially lower risk of adverse renal outcomes, regardless of the prior assigned glycemic control strategy. Interventional trials may be useful to help determine whether the currently recommended BP target of 140/90 mmHg may be too high for optimal renal protection in type 1 diabetes.",
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AB - OBJECTIVE To compare different blood pressure (BP) levels in their associationwith the risk of renal outcomes in type 1 diabetes and to determine whether an intensive glycemic control strategy modifies this association. RESEARCH DESIGN AND METHODS We included 1,441 participants with type 1 diabetes between the ages of 13 and 39 years who had previously been randomized to receive intensive versus conventional glycemic control in the Diabetes Control and Complications Trial (DCCT). The exposures of interest were time-updated systolic BP (SBP) and diastolic BP (DBP) categories. Outcomes included macroalbuminuria (>300 mg/24 h) or stage III chronic kidney disease (CKD) (sustained estimated glomerular filtration rate <60 mL/min/1.73 m2). RESULTS During a median follow-up time of 24 years, there were 84 cases of stage III CKD and 169 cases of macroalbuminuria. In adjusted models, SBP in the <120 mmHg range was associated with a 0.59 times higher risk of macroalbuminuria (95% CI 0.37-0.95) and a 0.32 times higher risk of stage III CKD (95% CI 0.14-0.75) compared with SBPs between 130 and 140 mmHg. DBP in the <70 mmHg range were associated with a 0.73 times higher risk of macroalbuminuria (95% CI 0.44-1.18) and a 0.47 times higher risk of stage III CKD (95% CI 0.21-1.05) compared with DBPs between 80 and 90 mmHg. No interaction was noted between BP and prior DCCT-assigned glycemic control strategy (all P > 0.05). CONCLUSIONS A lower BP (<120/70 mmHg) was associated with a substantially lower risk of adverse renal outcomes, regardless of the prior assigned glycemic control strategy. Interventional trials may be useful to help determine whether the currently recommended BP target of 140/90 mmHg may be too high for optimal renal protection in type 1 diabetes.

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