Lowering Blood Pressure Reduces Renal Events in Type 2 Diabetes
Identifieur interne : 002E47 ( PascalFrancis/Corpus ); précédent : 002E46; suivant : 002E48Lowering Blood Pressure Reduces Renal Events in Type 2 Diabetes
Auteurs : Bastiaan E. De Galan ; Vlado Perkovic ; Toshiharu Ninomiya ; Avinesh Pillai ; Anushka Patel ; Alan Cass ; Bruce Neal ; Neil Poulter ; Stephen Harrap ; Carl-Erik Mogensen ; Mark Cooper ; Michel Marre ; Bryan Williams ; Pavel Hamet ; Giuseppe Mancia ; Mark Woodward ; Paul Glasziou ; Diederick E. Grobbee ; Stephen Macmahon ; John ChalmersSource :
- 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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Pour connaître la documentation sur le format Inist Standard.
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Format Inist (serveur)
NO : | PASCAL 09-0193729 INIST |
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ET : | Lowering Blood Pressure Reduces Renal Events in Type 2 Diabetes |
AU : | DE GALAN (Bastiaan E.); PERKOVIC (Vlado); NINOMIYA (Toshiharu); PILLAI (Avinesh); PATEL (Anushka); CASS (Alan); NEAL (Bruce); POULTER (Neil); HARRAP (Stephen); MOGENSEN (Carl-Erik); COOPER (Mark); MARRE (Michel); WILLIAMS (Bryan); HAMET (Pavel); MANCIA (Giuseppe); WOODWARD (Mark); GLASZIOU (Paul); GROBBEE (Diederick E.); MACMAHON (Stephen); CHALMERS (John) |
AF : | George Institute For International Health, University of Sydney/Sydney/Australie (1 aut., 2 aut., 3 aut., 4 aut., 5 aut., 6 aut., 7 aut., 16 aut., 19 aut., 20 aut.); Department of General Internal Medicine, Radboud University Nijmegen Medical Centre/Nijmegen/Pays-Bas (1 aut.); International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London/London/Royaume-Uni (8 aut.); Department of Physiology, University of Melbourne/Melbourne/Australie (9 aut.); Medical Department M, Aarhus University Hospital, Aarhus Sygehus/Aarhus/Danemark (10 aut.); Danielle Alberti Memorial Centre for Diabetes Complications, Baker Heart Research Institute/Melbourne/Australie (11 aut.); Service d'Endocrinologie Diabétologie Nutrition, Groupe Hospitalier Bichat-Claude Bernard/Paris/France (12 aut.); Department of Cardiovascular Sciences, University of Leicester School of Medicine/Leicester/Royaume-Uni (13 aut.); Research Centre, Centre hospitalier de l'Université de Montréal (CHUM)/Montreal, Québec/Canada (14 aut.); Department of Clinical Medicine and Prevention, University of Milano-Bicocca/Milan/Italie (15 aut.); Centre for Evidence-Based Practice, Institute of Health Sciences, Oxford University/Oxford/Royaume-Uni (17 aut.); Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht/Utrecht/Pays-Bas (18 aut.) |
DT : | Publication en série; Niveau analytique |
SO : | Journal of the American Society of Nephrology; ISSN 1046-6673; Coden JASNEU; Etats-Unis; Da. 2009; Vol. 20; No. 4; Pp. 883-892; Bibl. 41 ref. |
LA : | Anglais |
EA : | 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. |
CC : | 002B14; 002B21E01A |
FD : | Diabète de type 2; Pression sanguine; Pression artérielle; Rein; Néphrologie; Urologie |
FG : | Hémodynamique; Appareil urinaire; Endocrinopathie; Maladie métabolique |
ED : | Type 2 diabetes; Blood pressure; Arterial pressure; Kidney; Nephrology; Urology |
EG : | Hemodynamics; Urinary system; Endocrinopathy; Metabolic diseases |
SD : | Diabetes de tipo 2; Presión sanguínea; Presión arterial; Riñón; Nefrología; Urología |
LO : | INIST-26049.354000185969410250 |
ID : | 09-0193729 |
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Pascal:09-0193729Le document en format XML
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Lowering Blood Pressure Reduces Renal Events in Type 2 Diabetes</title>
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<author><name sortKey="Mogensen, Carl Erik" sort="Mogensen, Carl Erik" uniqKey="Mogensen C" first="Carl-Erik" last="Mogensen">Carl-Erik Mogensen</name>
<affiliation><inist:fA14 i1="05"><s1>Medical Department M, Aarhus University Hospital, Aarhus Sygehus</s1>
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<author><name sortKey="Cooper, Mark" sort="Cooper, Mark" uniqKey="Cooper M" first="Mark" last="Cooper">Mark Cooper</name>
<affiliation><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>
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<author><name sortKey="Marre, Michel" sort="Marre, Michel" uniqKey="Marre M" first="Michel" last="Marre">Michel Marre</name>
<affiliation><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>
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<author><name sortKey="Williams, Bryan" sort="Williams, Bryan" uniqKey="Williams B" first="Bryan" last="Williams">Bryan Williams</name>
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<s2>Leicester</s2>
<s3>GBR</s3>
<sZ>13 aut.</sZ>
</inist:fA14>
</affiliation>
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<author><name sortKey="Hamet, Pavel" sort="Hamet, Pavel" uniqKey="Hamet P" first="Pavel" last="Hamet">Pavel Hamet</name>
<affiliation><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>
</affiliation>
</author>
<author><name sortKey="Mancia, Giuseppe" sort="Mancia, Giuseppe" uniqKey="Mancia G" first="Giuseppe" last="Mancia">Giuseppe Mancia</name>
<affiliation><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>
</affiliation>
</author>
<author><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name>
<affiliation><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>
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</affiliation>
</author>
<author><name sortKey="Glasziou, Paul" sort="Glasziou, Paul" uniqKey="Glasziou P" first="Paul" last="Glasziou">Paul Glasziou</name>
<affiliation><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>
</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><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>
</affiliation>
</author>
<author><name sortKey="Macmahon, Stephen" sort="Macmahon, Stephen" uniqKey="Macmahon S" first="Stephen" last="Macmahon">Stephen Macmahon</name>
<affiliation><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>
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<author><name sortKey="Chalmers, John" sort="Chalmers, John" uniqKey="Chalmers J" first="John" last="Chalmers">John Chalmers</name>
<affiliation><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>
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<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>
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<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>
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<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>
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<fA08 i1="01" i2="1" l="ENG"><s1>Lowering Blood Pressure Reduces Renal Events in Type 2 Diabetes</s1>
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<fA11 i1="01" i2="1"><s1>DE GALAN (Bastiaan E.)</s1>
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<fA11 i1="02" i2="1"><s1>PERKOVIC (Vlado)</s1>
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<fA11 i1="03" i2="1"><s1>NINOMIYA (Toshiharu)</s1>
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<fA11 i1="07" i2="1"><s1>NEAL (Bruce)</s1>
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<fA11 i1="17" i2="1"><s1>GLASZIOU (Paul)</s1>
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<fA11 i1="18" i2="1"><s1>GROBBEE (Diederick E.)</s1>
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<fA11 i1="19" i2="1"><s1>MACMAHON (Stephen)</s1>
</fA11>
<fA11 i1="20" i2="1"><s1>CHALMERS (John)</s1>
</fA11>
<fA14 i1="01"><s1>George Institute For International Health, University of Sydney</s1>
<s2>Sydney</s2>
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<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>
</fA14>
<fA14 i1="02"><s1>Department of General Internal Medicine, Radboud University Nijmegen Medical Centre</s1>
<s2>Nijmegen</s2>
<s3>NLD</s3>
<sZ>1 aut.</sZ>
</fA14>
<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>
</fA14>
<fA14 i1="04"><s1>Department of Physiology, University of Melbourne</s1>
<s2>Melbourne</s2>
<s3>AUS</s3>
<sZ>9 aut.</sZ>
</fA14>
<fA14 i1="05"><s1>Medical Department M, Aarhus University Hospital, Aarhus Sygehus</s1>
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<fA14 i1="06"><s1>Danielle Alberti Memorial Centre for Diabetes Complications, Baker Heart Research Institute</s1>
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<sZ>11 aut.</sZ>
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<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>
</fA14>
<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>
</fA14>
<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>
</fA14>
<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>
</fA14>
<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>
</fA14>
<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>
</fA14>
<fA17 i1="01" i2="1"><s1>ADVANCE Collaborative Group</s1>
<s3>INC</s3>
</fA17>
<fA20><s1>883-892</s1>
</fA20>
<fA21><s1>2009</s1>
</fA21>
<fA23 i1="01"><s0>ENG</s0>
</fA23>
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<fA44><s0>0000</s0>
<s1>© 2009 INIST-CNRS. All rights reserved.</s1>
</fA44>
<fA45><s0>41 ref.</s0>
</fA45>
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<fC01 i1="01" l="ENG"><s0>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.</s0>
</fC01>
<fC02 i1="01" i2="X"><s0>002B14</s0>
</fC02>
<fC02 i1="02" i2="X"><s0>002B21E01A</s0>
</fC02>
<fC03 i1="01" i2="X" l="FRE"><s0>Diabète de type 2</s0>
<s2>NM</s2>
<s5>01</s5>
</fC03>
<fC03 i1="01" i2="X" l="ENG"><s0>Type 2 diabetes</s0>
<s2>NM</s2>
<s5>01</s5>
</fC03>
<fC03 i1="01" i2="X" l="SPA"><s0>Diabetes de tipo 2</s0>
<s2>NM</s2>
<s5>01</s5>
</fC03>
<fC03 i1="02" i2="X" l="FRE"><s0>Pression sanguine</s0>
<s5>02</s5>
</fC03>
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<s5>02</s5>
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<s5>02</s5>
</fC03>
<fC03 i1="03" i2="X" l="FRE"><s0>Pression artérielle</s0>
<s5>03</s5>
</fC03>
<fC03 i1="03" i2="X" l="ENG"><s0>Arterial pressure</s0>
<s5>03</s5>
</fC03>
<fC03 i1="03" i2="X" l="SPA"><s0>Presión arterial</s0>
<s5>03</s5>
</fC03>
<fC03 i1="04" i2="X" l="FRE"><s0>Rein</s0>
<s5>05</s5>
</fC03>
<fC03 i1="04" i2="X" l="ENG"><s0>Kidney</s0>
<s5>05</s5>
</fC03>
<fC03 i1="04" i2="X" l="SPA"><s0>Riñón</s0>
<s5>05</s5>
</fC03>
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<s5>06</s5>
</fC03>
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<s5>06</s5>
</fC03>
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<s5>06</s5>
</fC03>
<fC03 i1="06" i2="X" l="FRE"><s0>Urologie</s0>
<s5>08</s5>
</fC03>
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<s5>08</s5>
</fC03>
<fC03 i1="06" i2="X" l="SPA"><s0>Urología</s0>
<s5>08</s5>
</fC03>
<fC07 i1="01" i2="X" l="FRE"><s0>Hémodynamique</s0>
<s5>37</s5>
</fC07>
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<s5>37</s5>
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<s5>37</s5>
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<s5>38</s5>
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<s5>38</s5>
</fC07>
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<s5>38</s5>
</fC07>
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<s5>39</s5>
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<s5>39</s5>
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<s5>39</s5>
</fC07>
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<s5>40</s5>
</fC07>
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<s5>40</s5>
</fC07>
<fC07 i1="04" i2="X" l="SPA"><s0>Metabolismo patología</s0>
<s5>40</s5>
</fC07>
<fN21><s1>138</s1>
</fN21>
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<server><NO>PASCAL 09-0193729 INIST</NO>
<ET>Lowering Blood Pressure Reduces Renal Events in Type 2 Diabetes</ET>
<AU>DE GALAN (Bastiaan E.); PERKOVIC (Vlado); NINOMIYA (Toshiharu); PILLAI (Avinesh); PATEL (Anushka); CASS (Alan); NEAL (Bruce); POULTER (Neil); HARRAP (Stephen); MOGENSEN (Carl-Erik); COOPER (Mark); MARRE (Michel); WILLIAMS (Bryan); HAMET (Pavel); MANCIA (Giuseppe); WOODWARD (Mark); GLASZIOU (Paul); GROBBEE (Diederick E.); MACMAHON (Stephen); CHALMERS (John)</AU>
<AF>George Institute For International Health, University of Sydney/Sydney/Australie (1 aut., 2 aut., 3 aut., 4 aut., 5 aut., 6 aut., 7 aut., 16 aut., 19 aut., 20 aut.); Department of General Internal Medicine, Radboud University Nijmegen Medical Centre/Nijmegen/Pays-Bas (1 aut.); International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London/London/Royaume-Uni (8 aut.); Department of Physiology, University of Melbourne/Melbourne/Australie (9 aut.); Medical Department M, Aarhus University Hospital, Aarhus Sygehus/Aarhus/Danemark (10 aut.); Danielle Alberti Memorial Centre for Diabetes Complications, Baker Heart Research Institute/Melbourne/Australie (11 aut.); Service d'Endocrinologie Diabétologie Nutrition, Groupe Hospitalier Bichat-Claude Bernard/Paris/France (12 aut.); Department of Cardiovascular Sciences, University of Leicester School of Medicine/Leicester/Royaume-Uni (13 aut.); Research Centre, Centre hospitalier de l'Université de Montréal (CHUM)/Montreal, Québec/Canada (14 aut.); Department of Clinical Medicine and Prevention, University of Milano-Bicocca/Milan/Italie (15 aut.); Centre for Evidence-Based Practice, Institute of Health Sciences, Oxford University/Oxford/Royaume-Uni (17 aut.); Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht/Utrecht/Pays-Bas (18 aut.)</AF>
<DT>Publication en série; Niveau analytique</DT>
<SO>Journal of the American Society of Nephrology; ISSN 1046-6673; Coden JASNEU; Etats-Unis; Da. 2009; Vol. 20; No. 4; Pp. 883-892; Bibl. 41 ref.</SO>
<LA>Anglais</LA>
<EA>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.</EA>
<CC>002B14; 002B21E01A</CC>
<FD>Diabète de type 2; Pression sanguine; Pression artérielle; Rein; Néphrologie; Urologie</FD>
<FG>Hémodynamique; Appareil urinaire; Endocrinopathie; Maladie métabolique</FG>
<ED>Type 2 diabetes; Blood pressure; Arterial pressure; Kidney; Nephrology; Urology</ED>
<EG>Hemodynamics; Urinary system; Endocrinopathy; Metabolic diseases</EG>
<SD>Diabetes de tipo 2; Presión sanguínea; Presión arterial; Riñón; Nefrología; Urología</SD>
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<ID>09-0193729</ID>
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