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Blood pressure status and the incidence of diabetic kidney disease in patients with hypertension and type 2 diabetes

De Cosmo, Salvatore; Viazzi, Francesca; Piscitelli, Pamela; Giorda, Carlo; Ceriello, Antonio; Genovese, Stefano; Russo, Giuseppina; Guida, Pietro; Fioretto, Paola; Pontremoli, Robertothe AMD-Annals Study Group

doi: 10.1097/HJH.0000000000001045

Objective: Antihypertensive treatment and blood pressure (BP) reduction are known to retard the progression of diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM) but long-term real-life clinical data on the incidence of DKD are lacking. In this observational, prospective cohort study, we investigated the association between achievement and maintenance of recommended BP values and the incidence of DKD and its components over a 4-year follow-up in patients with T2DM and hypertension from the Italian Medical Diabetologists registry.

Methods: Clinical records from a total of 12 995 patients with normal renal function and urine albumin excretion at baseline and regular visits during a 4-year follow-up were retrieved and analyzed. The association between recommended, time-updated BP control (BPC) (i.e. ≥75% of visits with SBP and DBP <140/85 mmHg) and the occurrence of renal outcomes was evaluated.

Results: At baseline, 28% of patients (n = 3612) had recommended BP values. Over the 4-year follow-up, 37% (n = 4845) developed DKD, 16% (n = 2061) low glomerular filtration rate and 27% (n = 3487) albuminuria. Patients who failed to achieve and maintain BPC over the study period showed an increased risk of developing DKD [odds ratio (OR) 1.38, P < 0.001], low glomerular filtration rate (OR 1.18, P = 0.03) and albuminuria (OR 1.47, P < 0.001) as compared with those with persistent BPC. These results were consistent after adjustment for covariates and in different subgroups.

Conclusion: Long-term BPC is associated with a reduction in the incidence of DKD and its components in patients with hypertension and T2DM.

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aDepartment of Medical Sciences, Scientific Institute ‘Casa Sollievo della Sofferenza’, Foggia

bUniversità degli Studi and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova

cDiabetes and Metabolism Unit, ASL Turin 5, Turin, Italy

dInstitut d’Investigacions Biomèdiques August Pii Sunyer (IDIBAPS) and Centro de Investigación Biomédicaen Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain

eDepartment of Cardiovascular and Metabolic Diseases, IRCCS Gruppo Multimedica, Milan

fDepartment of Clinical and Experimental Medicine, University of Messina, Messina

gAssociazione Medici Diabetologi, Rome

hDepartment of Medicine, University of Padua, Padua, Italy

Correspondence to Salvatore De Cosmo, Department of Medical Sciences, Scientific Institute ‘Casa Sollievo della Sofferenza’, Viale Cappuccini 1, San Giovanni Rotondo, 71013 Foggia, Italy. Tel: +39 0882410627; fax: +39 0882410627; e-mail:

Abbreviations: AMD, Italian Medical Diabetologists; BP, blood pressure; BPC, blood pressure control; DKD, diabetic kidney disease; eGFR, estimated glomerular filtration rate; HDL-c, HDL cholesterol; LDL-c, LDL cholesterol; T2DM, type 2 diabetes mellitus

Received 30 March, 2016

Revised 23 May, 2016

Accepted 17 June, 2016

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