Esrd

28 (p =

- 0.002)

23 (p =

0.07)

23 (p = 0.07)

0(p =

0.99)

Death

-2 (p =

- 0.88)

8 (p =

0.57)

-4 (p = 0.8)

12 (p =

0.4)

CV morbidity & mortality

10 (p =

0.26)

9 (p =

: 0.4)

-3 (p = 0.79)

12 (p =

0.29)

Abbreviations: ESRD, end-stage-renal-disease, CV, cardiovascular; IDNT, irbesartan diabetic nephropathy trial; RENAAL, reduction of endpoints in non-insulin dependent diabetes mellitus with the angiotensin II antagonist losartan; vs, versus. Source: From Refs. 47 and 48.

Abbreviations: ESRD, end-stage-renal-disease, CV, cardiovascular; IDNT, irbesartan diabetic nephropathy trial; RENAAL, reduction of endpoints in non-insulin dependent diabetes mellitus with the angiotensin II antagonist losartan; vs, versus. Source: From Refs. 47 and 48.

decreased risk for stroke. Increased pulse pressure predicted increased all-cause mortality, CV mortality, myocardial infarction, and chronic heart failure (50). The IDNT investigators concluded that achieved SBP approaching 120 mmHg and DBP of 85 mmHg are associated with the best protection against CV events in these patients, whereas BP < or = 120/85 may be associated with an increase in CV events.

In the RENAAL (Reduction of Endpoints in Non-Insulin Dependent Diabetes mellitus with the Angiotensin II Antagonist Losartan) Study (48) the renal protective effect of Losartan (50 to 100mg/day) was studied in comparison with placebo in 1513 hypertensive T2DM patients with proteinuria. In both treatment groups conventional antihypertensive drugs like CCB, diuretics, BB and a1 specific blockers were used. In comparison with the control group treatment with losartan (48) reduced the risk (Table 3) for progression to ESRD by 28% (p = 0.002) and the risk for doubling of serum creatinine by 25% (p = 0.006). By contrast, the death risk did not significantly differ between the two groups (21.0 vs. 20.3%). A recently published post-hoc analysis of the RENAAL study (52) showed that treatment-induced changes in SBP and albuminuria do not run parallel in a substantial proportion of patients. Among patients with a reduced SBP during treatment, a lack of albuminuria reduction was observed in 37%, 26%, and 51% (total, losartan, and placebo, respectively) at 6 months. SBP or albuminuria reduction was associated with a lower risk for ESRD, whereas combined SBP and albuminuria reduction was associated with the lowest risk for events. Antihypertensive treatment that is aimed at improving renal outcomes in patients with DN may therefore require a dual strategy, targeting both SBP and albuminuria reduction.

FIGURE 4 Simultaneous impact of quartile of achieved systolic BP and treatment modality on the relative risk for reaching a renal endpoint. Source: From Ref. 51.
Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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