Lowering Blood Pressure Reduces Renal Events in Type 2 Diabetes
Identifieur interne : 008235 ( Main/Exploration ); précédent : 008234; suivant : 008236Lowering Blood Pressure Reduces Renal Events in Type 2 Diabetes
Auteurs : Bastiaan E. De Galan [Australie, Pays-Bas] ; Vlado Perkovic [Australie] ; Toshiharu Ninomiya [Australie] ; Avinesh Pillai [Australie] ; Anushka Patel [Australie] ; Alan Cass [Australie] ; Bruce Neal [Australie] ; Neil Poulter [Royaume-Uni] ; Stephen Harrap [Australie] ; Carl-Erik Mogensen [Danemark] ; Mark Cooper [Australie] ; Michel Marre [France] ; Bryan Williams [Royaume-Uni] ; Pavel Hamet [Canada] ; Giuseppe Mancia [Italie] ; Mark Woodward [Australie] ; Paul Glasziou [Royaume-Uni] ; Diederick E. Grobbee [Pays-Bas] ; Stephen Macmahon [Australie] ; John Chalmers [Australie]Source :
- Journal of the American Society of Nephrology [ 1046-6673 ] ; 2009.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
Abstract
BP is an important determinant of kidney disease among patients with diabetes. The recommended thresholds to initiate treatment to lower BP are 130/80 and 125/75 mmHg for people with diabetes and nephropathy, respectively. We sought to determine the effects of lowering BP below these currently recommended thresholds on renal outcomes among 11,140 patients who had type 2 diabetes and participated in the Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study. Patients were randomly assigned to fixed combination perindopril-indapamide or placebo, regardless of their BP at entry. During a mean follow-up of 4.3 yr, active treatment reduced the risk for renal events by 21% (P < 0.0001), which was driven by reduced risks for developing microalbuminuria and macroalbuminuria (both P < 0.003). Effects of active treatment were consistent across subgroups defined by baseline systolic or diastolic BP. Lower systolic BP levels during follow-up, even to <110 mmHg, was associated with progressively lower rates of renal events. In conclusion, BP-lowering treatment with perindopril-indapamide administered routinely to individuals with type 2 diabetes provides important renoprotection, even among those with initial BP <120/70 mmHg. We could not identify a BP threshold below which renal benefit is lost.
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Affiliations:
- Australie, Canada, Danemark, France, Italie, Pays-Bas, Royaume-Uni
- Angleterre, Grand Londres, Gueldre, Lombardie, Nouvelle-Galles du Sud, Oxfordshire, Utrecht (province), Victoria (État), Île-de-France
- Londres, Melbourne, Milan, Nimègue, Oxford, Paris, Sydney, Utrecht
- Université de Melbourne, Université de Sydney
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aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>16 aut.</sZ><sZ>19 aut.</sZ><sZ>20 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Pillai, Avinesh" sort="Pillai, Avinesh" uniqKey="Pillai A" first="Avinesh" last="Pillai">Avinesh Pillai</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute For International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>16 aut.</sZ><sZ>19 aut.</sZ><sZ>20 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Patel, Anushka" sort="Patel, Anushka" uniqKey="Patel A" first="Anushka" last="Patel">Anushka Patel</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute For International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>16 aut.</sZ><sZ>19 aut.</sZ><sZ>20 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Cass, Alan" sort="Cass, Alan" uniqKey="Cass A" first="Alan" last="Cass">Alan Cass</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute For International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>16 aut.</sZ><sZ>19 aut.</sZ><sZ>20 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Neal, Bruce" sort="Neal, Bruce" uniqKey="Neal B" first="Bruce" last="Neal">Bruce Neal</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute For International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>16 aut.</sZ><sZ>19 aut.</sZ><sZ>20 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Poulter, Neil" sort="Poulter, Neil" uniqKey="Poulter N" first="Neil" last="Poulter">Neil Poulter</name><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London</s1><s2>London</s2><s3>GBR</s3><sZ>8 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Harrap, Stephen" sort="Harrap, Stephen" uniqKey="Harrap S" first="Stephen" last="Harrap">Stephen Harrap</name><affiliation wicri:level="4"><inist:fA14 i1="04"><s1>Department of Physiology, University of Melbourne</s1><s2>Melbourne</s2><s3>AUS</s3><sZ>9 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region><settlement type="city">Melbourne</settlement></placeName><orgName type="university">Université de Melbourne</orgName></affiliation></author><author><name sortKey="Mogensen, Carl Erik" sort="Mogensen, Carl Erik" uniqKey="Mogensen C" first="Carl-Erik" last="Mogensen">Carl-Erik Mogensen</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Medical Department M, Aarhus University Hospital, Aarhus Sygehus</s1><s2>Aarhus</s2><s3>DNK</s3><sZ>10 aut.</sZ></inist:fA14><country>Danemark</country><wicri:noRegion>Aarhus</wicri:noRegion></affiliation></author><author><name sortKey="Cooper, Mark" sort="Cooper, Mark" uniqKey="Cooper M" first="Mark" last="Cooper">Mark Cooper</name><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Danielle Alberti Memorial Centre for Diabetes Complications, Baker Heart Research Institute</s1><s2>Melbourne</s2><s3>AUS</s3><sZ>11 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation></author><author><name sortKey="Marre, Michel" sort="Marre, Michel" uniqKey="Marre M" first="Michel" last="Marre">Michel Marre</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Service d'Endocrinologie Diabétologie Nutrition, Groupe Hospitalier Bichat-Claude Bernard</s1><s2>Paris</s2><s3>FRA</s3><sZ>12 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Williams, Bryan" sort="Williams, Bryan" uniqKey="Williams B" first="Bryan" last="Williams">Bryan Williams</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Department of Cardiovascular Sciences, University of Leicester School of Medicine</s1><s2>Leicester</s2><s3>GBR</s3><sZ>13 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Leicester</wicri:noRegion></affiliation></author><author><name sortKey="Hamet, Pavel" sort="Hamet, Pavel" uniqKey="Hamet P" first="Pavel" last="Hamet">Pavel Hamet</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>Research Centre, Centre hospitalier de l'Université de Montréal (CHUM)</s1><s2>Montreal, Québec</s2><s3>CAN</s3><sZ>14 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Montreal, Québec</wicri:noRegion></affiliation></author><author><name sortKey="Mancia, Giuseppe" sort="Mancia, Giuseppe" uniqKey="Mancia G" first="Giuseppe" last="Mancia">Giuseppe Mancia</name><affiliation wicri:level="3"><inist:fA14 i1="10"><s1>Department of Clinical Medicine and Prevention, University of Milano-Bicocca</s1><s2>Milan</s2><s3>ITA</s3><sZ>15 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute For International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>16 aut.</sZ><sZ>19 aut.</sZ><sZ>20 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Glasziou, Paul" sort="Glasziou, Paul" uniqKey="Glasziou P" first="Paul" last="Glasziou">Paul Glasziou</name><affiliation wicri:level="3"><inist:fA14 i1="11"><s1>Centre for Evidence-Based Practice, Institute of Health Sciences, Oxford University</s1><s2>Oxford</s2><s3>GBR</s3><sZ>17 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Oxford</settlement><region type="country">Angleterre</region><region type="comté" nuts="2">Oxfordshire</region></placeName></affiliation></author><author><name sortKey="Grobbee, Diederick E" sort="Grobbee, Diederick E" uniqKey="Grobbee D" first="Diederick E." last="Grobbee">Diederick E. Grobbee</name><affiliation wicri:level="3"><inist:fA14 i1="12"><s1>Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht</s1><s2>Utrecht</s2><s3>NLD</s3><sZ>18 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Utrecht</settlement><region nuts="2" type="province">Utrecht (province)</region></placeName></affiliation></author><author><name sortKey="Macmahon, Stephen" sort="Macmahon, Stephen" uniqKey="Macmahon S" first="Stephen" last="Macmahon">Stephen Macmahon</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute For International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>16 aut.</sZ><sZ>19 aut.</sZ><sZ>20 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Chalmers, John" sort="Chalmers, John" uniqKey="Chalmers J" first="John" last="Chalmers">John Chalmers</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute For International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>16 aut.</sZ><sZ>19 aut.</sZ><sZ>20 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author></analytic><series><title level="j" type="main">Journal of the American Society of Nephrology</title><title level="j" type="abbreviated">J. Am. Soc. Nephrol.</title><idno type="ISSN">1046-6673</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Journal of the American Society of Nephrology</title><title level="j" type="abbreviated">J. Am. Soc. Nephrol.</title><idno type="ISSN">1046-6673</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Arterial pressure</term><term>Blood pressure</term><term>Kidney</term><term>Nephrology</term><term>Type 2 diabetes</term><term>Urology</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Diabète de type 2</term><term>Pression sanguine</term><term>Pression artérielle</term><term>Rein</term><term>Néphrologie</term><term>Urologie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">BP is an important determinant of kidney disease among patients with diabetes. The recommended thresholds to initiate treatment to lower BP are 130/80 and 125/75 mmHg for people with diabetes and nephropathy, respectively. We sought to determine the effects of lowering BP below these currently recommended thresholds on renal outcomes among 11,140 patients who had type 2 diabetes and participated in the Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study. Patients were randomly assigned to fixed combination perindopril-indapamide or placebo, regardless of their BP at entry. During a mean follow-up of 4.3 yr, active treatment reduced the risk for renal events by 21% (P < 0.0001), which was driven by reduced risks for developing microalbuminuria and macroalbuminuria (both P < 0.003). Effects of active treatment were consistent across subgroups defined by baseline systolic or diastolic BP. Lower systolic BP levels during follow-up, even to <110 mmHg, was associated with progressively lower rates of renal events. In conclusion, BP-lowering treatment with perindopril-indapamide administered routinely to individuals with type 2 diabetes provides important renoprotection, even among those with initial BP <120/70 mmHg. We could not identify a BP threshold below which renal benefit is lost.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Canada</li><li>Danemark</li><li>France</li><li>Italie</li><li>Pays-Bas</li><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Londres</li><li>Gueldre</li><li>Lombardie</li><li>Nouvelle-Galles du Sud</li><li>Oxfordshire</li><li>Utrecht (province)</li><li>Victoria (État)</li><li>Île-de-France</li></region><settlement><li>Londres</li><li>Melbourne</li><li>Milan</li><li>Nimègue</li><li>Oxford</li><li>Paris</li><li>Sydney</li><li>Utrecht</li></settlement><orgName><li>Université de Melbourne</li><li>Université de Sydney</li></orgName></list><tree><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="De Galan, Bastiaan E" sort="De Galan, Bastiaan E" uniqKey="De Galan B" first="Bastiaan E." last="De Galan">Bastiaan E. De Galan</name></region><name sortKey="Cass, Alan" sort="Cass, Alan" uniqKey="Cass A" first="Alan" last="Cass">Alan Cass</name><name sortKey="Chalmers, John" sort="Chalmers, John" uniqKey="Chalmers J" first="John" last="Chalmers">John Chalmers</name><name sortKey="Cooper, Mark" sort="Cooper, Mark" uniqKey="Cooper M" first="Mark" last="Cooper">Mark Cooper</name><name sortKey="Harrap, Stephen" sort="Harrap, Stephen" uniqKey="Harrap S" first="Stephen" last="Harrap">Stephen Harrap</name><name sortKey="Macmahon, Stephen" sort="Macmahon, Stephen" uniqKey="Macmahon S" first="Stephen" last="Macmahon">Stephen Macmahon</name><name sortKey="Neal, Bruce" sort="Neal, Bruce" uniqKey="Neal B" first="Bruce" last="Neal">Bruce Neal</name><name sortKey="Ninomiya, Toshiharu" sort="Ninomiya, Toshiharu" uniqKey="Ninomiya T" first="Toshiharu" last="Ninomiya">Toshiharu Ninomiya</name><name sortKey="Patel, Anushka" sort="Patel, Anushka" uniqKey="Patel A" first="Anushka" last="Patel">Anushka Patel</name><name sortKey="Perkovic, Vlado" sort="Perkovic, Vlado" uniqKey="Perkovic V" first="Vlado" last="Perkovic">Vlado Perkovic</name><name sortKey="Pillai, Avinesh" sort="Pillai, Avinesh" uniqKey="Pillai A" first="Avinesh" last="Pillai">Avinesh Pillai</name><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name></country><country name="Pays-Bas"><region name="Gueldre"><name sortKey="De Galan, Bastiaan E" sort="De Galan, Bastiaan E" uniqKey="De Galan B" first="Bastiaan E." last="De Galan">Bastiaan E. De Galan</name></region><name sortKey="Grobbee, Diederick E" sort="Grobbee, Diederick E" uniqKey="Grobbee D" first="Diederick E." last="Grobbee">Diederick E. Grobbee</name></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Poulter, Neil" sort="Poulter, Neil" uniqKey="Poulter N" first="Neil" last="Poulter">Neil Poulter</name></region><name sortKey="Glasziou, Paul" sort="Glasziou, Paul" uniqKey="Glasziou P" first="Paul" last="Glasziou">Paul Glasziou</name><name sortKey="Williams, Bryan" sort="Williams, Bryan" uniqKey="Williams B" first="Bryan" last="Williams">Bryan Williams</name></country><country name="Danemark"><noRegion><name sortKey="Mogensen, Carl Erik" sort="Mogensen, Carl Erik" uniqKey="Mogensen C" first="Carl-Erik" last="Mogensen">Carl-Erik Mogensen</name></noRegion></country><country name="France"><region name="Île-de-France"><name sortKey="Marre, Michel" sort="Marre, Michel" uniqKey="Marre M" first="Michel" last="Marre">Michel Marre</name></region></country><country name="Canada"><noRegion><name sortKey="Hamet, Pavel" sort="Hamet, Pavel" uniqKey="Hamet P" first="Pavel" last="Hamet">Pavel Hamet</name></noRegion></country><country name="Italie"><region name="Lombardie"><name sortKey="Mancia, Giuseppe" sort="Mancia, Giuseppe" uniqKey="Mancia G" first="Giuseppe" last="Mancia">Giuseppe Mancia</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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