Independent and Additive Impact of Blood Pressure Control and Angiotensin II Receptor Blockade on Renal Outcomes in the Irbesartan Diabetic Nephropathy Trial: Clinical Implications and Limitations

摘要: Elevated arterial pressure is a major risk factor for progression to ESRD in diabetic nephropathy. However, the component of and level BP control optimal renal outcomes are disputed. Data from 1590 hypertensive patients with type 2 diabetes Irbesartan Diabetic Nephropathy Trial (IDNT), randomized, double-blind, placebo-controlled trial performed 209 clinics worldwide, were examined, effects baseline mean follow-up systolic (SBP) diastolic interaction assigned study medications (irbesartan, amlodipine, placebo) on progressive failure all-cause mortality assessed. Other antihypertensive agents added achieve predetermined goals. Entry criteria included elevated serum creatinine concentration up 266 micromol/L (3.0 mg/dl) urine protein excretion >900 mg/d. Baseline averaged 159/87 +/- 20/11 mmHg. Median patient was 2.6 yr. Follow-up achieved SBP most strongly predicted outcomes. >149 mmHg associated 2.2-fold increase doubling or compared <134 Progressive lowering 120 improved survival, an effect independent function. Below this threshold, increased. An additional renoprotective irbesartan, SBP, observed down There no correlation between We recommend target 130 mmHg, conjunction blockade renin-angiotensin system,