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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Lowering Blood Pressure Reduces Renal Events in Type 2 Diabetes</title><author><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><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">George Institute For International Health, University of Sydney, Sydney, Australia;</nlm:aff></affiliation><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands;</nlm:aff></affiliation></author><author><name sortKey="Perkovic, Vlado" sort="Perkovic, Vlado" uniqKey="Perkovic V" first="Vlado" last="Perkovic">Vlado Perkovic</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">George Institute For International Health, University of Sydney, Sydney, Australia;</nlm:aff></affiliation></author><author><name sortKey="Ninomiya, Toshiharu" sort="Ninomiya, Toshiharu" uniqKey="Ninomiya T" first="Toshiharu" last="Ninomiya">Toshiharu Ninomiya</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">George Institute For International Health, University of Sydney, Sydney, Australia;</nlm:aff></affiliation></author><author><name sortKey="Pillai, Avinesh" sort="Pillai, Avinesh" uniqKey="Pillai A" first="Avinesh" last="Pillai">Avinesh Pillai</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">George Institute For International Health, University of Sydney, Sydney, Australia;</nlm:aff></affiliation></author><author><name sortKey="Patel, Anushka" sort="Patel, Anushka" uniqKey="Patel A" first="Anushka" last="Patel">Anushka Patel</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">George Institute For International Health, University of Sydney, Sydney, Australia;</nlm:aff></affiliation></author><author><name sortKey="Cass, Alan" sort="Cass, Alan" uniqKey="Cass A" first="Alan" last="Cass">Alan Cass</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">George Institute For International Health, University of Sydney, Sydney, Australia;</nlm:aff></affiliation></author><author><name sortKey="Neal, Bruce" sort="Neal, Bruce" uniqKey="Neal B" first="Bruce" last="Neal">Bruce Neal</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">George Institute For International Health, University of Sydney, Sydney, Australia;</nlm:aff></affiliation></author><author><name sortKey="Poulter, Neil" sort="Poulter, Neil" uniqKey="Poulter N" first="Neil" last="Poulter">Neil Poulter</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom;</nlm:aff></affiliation></author><author><name sortKey="Harrap, Stephen" sort="Harrap, Stephen" uniqKey="Harrap S" first="Stephen" last="Harrap">Stephen Harrap</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">Department of Physiology, University of Melbourne, Melbourne Australia;</nlm:aff></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><nlm:aff id="N0x1a54b90N0x1f05e28">Medical Department M, Aarhus University Hospital, Aarhus Sygehus, Aarhus C, Denmark;</nlm:aff></affiliation></author><author><name sortKey="Cooper, Mark" sort="Cooper, Mark" uniqKey="Cooper M" first="Mark" last="Cooper">Mark Cooper</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">Danielle Alberti Memorial Centre for Diabetes Complications, Baker Heart Research Institute, Melbourne, Australia;</nlm:aff></affiliation></author><author><name sortKey="Marre, Michel" sort="Marre, Michel" uniqKey="Marre M" first="Michel" last="Marre">Michel Marre</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">Service d'Endocrinologie Diabétologie Nutrition, Groupe Hospitalier Bichat–Claude Bernard, Paris, France;</nlm:aff></affiliation></author><author><name sortKey="Williams, Bryan" sort="Williams, Bryan" uniqKey="Williams B" first="Bryan" last="Williams">Bryan Williams</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">Department of Cardiovascular Sciences, University of Leicester School of Medicine, Leicester, United Kingdom;</nlm:aff></affiliation></author><author><name sortKey="Hamet, Pavel" sort="Hamet, Pavel" uniqKey="Hamet P" first="Pavel" last="Hamet">Pavel Hamet</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">Research Centre, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada;</nlm:aff></affiliation></author><author><name sortKey="Mancia, Giuseppe" sort="Mancia, Giuseppe" uniqKey="Mancia G" first="Giuseppe" last="Mancia">Giuseppe Mancia</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy;</nlm:aff></affiliation></author><author><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">George Institute For International Health, University of Sydney, Sydney, Australia;</nlm:aff></affiliation></author><author><name sortKey="Glasziou, Paul" sort="Glasziou, Paul" uniqKey="Glasziou P" first="Paul" last="Glasziou">Paul Glasziou</name><affiliation><nlm:aff wicri:cut="; and" id="N0x1a54b90N0x1f05e28">Centre for Evidence-Based Practice, Institute of Health Sciences, Oxford University, Oxford, United Kingdom</nlm:aff></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><nlm:aff id="N0x1a54b90N0x1f05e28">Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands</nlm:aff></affiliation></author><author><name sortKey="Macmahon, Stephen" sort="Macmahon, Stephen" uniqKey="Macmahon S" first="Stephen" last="Macmahon">Stephen Macmahon</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">George Institute For International Health, University of Sydney, Sydney, Australia;</nlm:aff></affiliation></author><author><name sortKey="Chalmers, John" sort="Chalmers, John" uniqKey="Chalmers J" first="John" last="Chalmers">John Chalmers</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">George Institute For International Health, University of Sydney, Sydney, Australia;</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">19225038</idno><idno type="pmc">2663832</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2663832</idno><idno type="RBID">PMC:2663832</idno><idno type="doi">10.1681/ASN.2008070667</idno><date when="2009">2009</date><idno type="wicri:Area/Pmc/Corpus">000F95</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000F95</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Lowering Blood Pressure Reduces Renal Events in Type 2 Diabetes</title><author><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><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">George Institute For International Health, University of Sydney, Sydney, Australia;</nlm:aff></affiliation><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands;</nlm:aff></affiliation></author><author><name sortKey="Perkovic, Vlado" sort="Perkovic, Vlado" uniqKey="Perkovic V" first="Vlado" last="Perkovic">Vlado Perkovic</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">George Institute For International Health, University of Sydney, Sydney, Australia;</nlm:aff></affiliation></author><author><name sortKey="Ninomiya, Toshiharu" sort="Ninomiya, Toshiharu" uniqKey="Ninomiya T" first="Toshiharu" last="Ninomiya">Toshiharu Ninomiya</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">George Institute For International Health, University of Sydney, Sydney, Australia;</nlm:aff></affiliation></author><author><name sortKey="Pillai, Avinesh" sort="Pillai, Avinesh" uniqKey="Pillai A" first="Avinesh" last="Pillai">Avinesh Pillai</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">George Institute For International Health, University of Sydney, Sydney, Australia;</nlm:aff></affiliation></author><author><name sortKey="Patel, Anushka" sort="Patel, Anushka" uniqKey="Patel A" first="Anushka" last="Patel">Anushka Patel</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">George Institute For International Health, University of Sydney, Sydney, Australia;</nlm:aff></affiliation></author><author><name sortKey="Cass, Alan" sort="Cass, Alan" uniqKey="Cass A" first="Alan" last="Cass">Alan Cass</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">George Institute For International Health, University of Sydney, Sydney, Australia;</nlm:aff></affiliation></author><author><name sortKey="Neal, Bruce" sort="Neal, Bruce" uniqKey="Neal B" first="Bruce" last="Neal">Bruce Neal</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">George Institute For International Health, University of Sydney, Sydney, Australia;</nlm:aff></affiliation></author><author><name sortKey="Poulter, Neil" sort="Poulter, Neil" uniqKey="Poulter N" first="Neil" last="Poulter">Neil Poulter</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom;</nlm:aff></affiliation></author><author><name sortKey="Harrap, Stephen" sort="Harrap, Stephen" uniqKey="Harrap S" first="Stephen" last="Harrap">Stephen Harrap</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">Department of Physiology, University of Melbourne, Melbourne Australia;</nlm:aff></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><nlm:aff id="N0x1a54b90N0x1f05e28">Medical Department M, Aarhus University Hospital, Aarhus Sygehus, Aarhus C, Denmark;</nlm:aff></affiliation></author><author><name sortKey="Cooper, Mark" sort="Cooper, Mark" uniqKey="Cooper M" first="Mark" last="Cooper">Mark Cooper</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">Danielle Alberti Memorial Centre for Diabetes Complications, Baker Heart Research Institute, Melbourne, Australia;</nlm:aff></affiliation></author><author><name sortKey="Marre, Michel" sort="Marre, Michel" uniqKey="Marre M" first="Michel" last="Marre">Michel Marre</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">Service d'Endocrinologie Diabétologie Nutrition, Groupe Hospitalier Bichat–Claude Bernard, Paris, France;</nlm:aff></affiliation></author><author><name sortKey="Williams, Bryan" sort="Williams, Bryan" uniqKey="Williams B" first="Bryan" last="Williams">Bryan Williams</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">Department of Cardiovascular Sciences, University of Leicester School of Medicine, Leicester, United Kingdom;</nlm:aff></affiliation></author><author><name sortKey="Hamet, Pavel" sort="Hamet, Pavel" uniqKey="Hamet P" first="Pavel" last="Hamet">Pavel Hamet</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">Research Centre, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada;</nlm:aff></affiliation></author><author><name sortKey="Mancia, Giuseppe" sort="Mancia, Giuseppe" uniqKey="Mancia G" first="Giuseppe" last="Mancia">Giuseppe Mancia</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy;</nlm:aff></affiliation></author><author><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">George Institute For International Health, University of Sydney, Sydney, Australia;</nlm:aff></affiliation></author><author><name sortKey="Glasziou, Paul" sort="Glasziou, Paul" uniqKey="Glasziou P" first="Paul" last="Glasziou">Paul Glasziou</name><affiliation><nlm:aff wicri:cut="; and" id="N0x1a54b90N0x1f05e28">Centre for Evidence-Based Practice, Institute of Health Sciences, Oxford University, Oxford, United Kingdom</nlm:aff></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><nlm:aff id="N0x1a54b90N0x1f05e28">Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands</nlm:aff></affiliation></author><author><name sortKey="Macmahon, Stephen" sort="Macmahon, Stephen" uniqKey="Macmahon S" first="Stephen" last="Macmahon">Stephen Macmahon</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">George Institute For International Health, University of Sydney, Sydney, Australia;</nlm:aff></affiliation></author><author><name sortKey="Chalmers, John" sort="Chalmers, John" uniqKey="Chalmers J" first="John" last="Chalmers">John Chalmers</name><affiliation><nlm:aff id="N0x1a54b90N0x1f05e28">George Institute For International Health, University of Sydney, Sydney, Australia;</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of the American Society of Nephrology : JASN</title><idno type="ISSN">1046-6673</idno><idno type="eISSN">1533-3450</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>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% (<italic>P</italic> < 0.0001), which was driven by reduced risks for developing microalbuminuria and macroalbuminuria (both <italic>P</italic> < 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.</p></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Am Soc Nephrol</journal-id><journal-id journal-id-type="publisher-id">JNEPHROL</journal-id><journal-title>Journal of the American Society of Nephrology : JASN</journal-title><issn pub-type="ppub">1046-6673</issn><issn pub-type="epub">1533-3450</issn><publisher><publisher-name>American Society of Nephrology</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">19225038</article-id><article-id pub-id-type="pmc">2663832</article-id><article-id pub-id-type="publisher-id">0667</article-id><article-id pub-id-type="doi">10.1681/ASN.2008070667</article-id><article-categories><subj-group subj-group-type="heading"><subject>Clinical Research</subject></subj-group></article-categories><title-group><article-title>Lowering Blood Pressure Reduces Renal Events in Type 2 Diabetes</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>de Galan</surname><given-names>Bastiaan E.</given-names></name><xref ref-type="aff" rid="N0x1a54b90N0x1f05e28">*</xref><xref ref-type="aff" rid="N0x1a54b90N0x1f05e28">†</xref></contrib><contrib contrib-type="author"><name><surname>Perkovic</surname><given-names>Vlado</given-names></name><xref ref-type="aff" rid="N0x1a54b90N0x1f05e28">*</xref></contrib><contrib contrib-type="author"><name><surname>Ninomiya</surname><given-names>Toshiharu</given-names></name><xref ref-type="aff" rid="N0x1a54b90N0x1f05e28">*</xref></contrib><contrib contrib-type="author"><name><surname>Pillai</surname><given-names>Avinesh</given-names></name><xref ref-type="aff" rid="N0x1a54b90N0x1f05e28">*</xref></contrib><contrib contrib-type="author"><name><surname>Patel</surname><given-names>Anushka</given-names></name><xref ref-type="aff" rid="N0x1a54b90N0x1f05e28">*</xref></contrib><contrib contrib-type="author"><name><surname>Cass</surname><given-names>Alan</given-names></name><xref ref-type="aff" rid="N0x1a54b90N0x1f05e28">*</xref></contrib><contrib contrib-type="author"><name><surname>Neal</surname><given-names>Bruce</given-names></name><xref ref-type="aff" rid="N0x1a54b90N0x1f05e28">*</xref></contrib><contrib contrib-type="author"><name><surname>Poulter</surname><given-names>Neil</given-names></name><xref ref-type="aff" rid="N0x1a54b90N0x1f05e28">‡</xref></contrib><contrib contrib-type="author"><name><surname>Harrap</surname><given-names>Stephen</given-names></name><xref ref-type="aff" rid="N0x1a54b90N0x1f05e28">§</xref></contrib><contrib contrib-type="author"><name><surname>Mogensen</surname><given-names>Carl-Erik</given-names></name><xref ref-type="aff" rid="N0x1a54b90N0x1f05e28">‖</xref></contrib><contrib contrib-type="author"><name><surname>Cooper</surname><given-names>Mark</given-names></name><xref ref-type="aff" rid="N0x1a54b90N0x1f05e28">¶</xref></contrib><contrib contrib-type="author"><name><surname>Marre</surname><given-names>Michel</given-names></name><xref ref-type="aff" rid="N0x1a54b90N0x1f05e28">**</xref></contrib><contrib contrib-type="author"><name><surname>Williams</surname><given-names>Bryan</given-names></name><xref ref-type="aff" rid="N0x1a54b90N0x1f05e28">††</xref></contrib><contrib contrib-type="author"><name><surname>Hamet</surname><given-names>Pavel</given-names></name><xref ref-type="aff" rid="N0x1a54b90N0x1f05e28">‡‡</xref></contrib><contrib contrib-type="author"><name><surname>Mancia</surname><given-names>Giuseppe</given-names></name><xref ref-type="aff" rid="N0x1a54b90N0x1f05e28">§§</xref></contrib><contrib contrib-type="author"><name><surname>Woodward</surname><given-names>Mark</given-names></name><xref ref-type="aff" rid="N0x1a54b90N0x1f05e28">*</xref></contrib><contrib contrib-type="author"><name><surname>Glasziou</surname><given-names>Paul</given-names></name><xref ref-type="aff" rid="N0x1a54b90N0x1f05e28">‖‖</xref></contrib><contrib contrib-type="author"><name><surname>Grobbee</surname><given-names>Diederick E.</given-names></name><xref ref-type="aff" rid="N0x1a54b90N0x1f05e28">¶¶</xref></contrib><contrib contrib-type="author"><name><surname>MacMahon</surname><given-names>Stephen</given-names></name><xref ref-type="aff" rid="N0x1a54b90N0x1f05e28">*</xref></contrib><contrib contrib-type="author"><name><surname>Chalmers</surname><given-names>John</given-names></name><xref ref-type="aff" rid="N0x1a54b90N0x1f05e28">*</xref></contrib><contrib contrib-type="author"><collab>on behalf of the ADVANCE Collaborative Group</collab></contrib></contrib-group><aff id="N0x1a54b90N0x1f05e28"><label>*</label>George Institute For International Health, University of Sydney, Sydney, Australia;<label>†</label>Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands;<label>‡</label>International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom;<label>§</label>Department of Physiology, University of Melbourne, Melbourne Australia;<label>‖</label>Medical Department M, Aarhus University Hospital, Aarhus Sygehus, Aarhus C, Denmark;<label>¶</label>Danielle Alberti Memorial Centre for Diabetes Complications, Baker Heart Research Institute, Melbourne, Australia;<label>**</label>Service d'Endocrinologie Diabétologie Nutrition, Groupe Hospitalier Bichat–Claude Bernard, Paris, France;<label>††</label>Department of Cardiovascular Sciences, University of Leicester School of Medicine, Leicester, United Kingdom;<label>‡‡</label>Research Centre, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada;<label>§§</label>Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy;<label>‖‖</label>Centre for Evidence-Based Practice, Institute of Health Sciences, Oxford University, Oxford, United Kingdom; and<label>¶¶</label>Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands</aff><author-notes><fn><p><bold>Correspondence:</bold> Dr. Vlado Perkovic, George Institute for International Health, University of Sydney, P.O. Box M201, Missenden Road, Sydney, NSW 2050, Australia. Phone: +61-2-9993-4523; Fax: +61-2-9993-4501; E-mail: <email>vperkovic@george.org.au</email></p></fn></author-notes><pub-date pub-type="ppub"><month>4</month><year>2009</year></pub-date><pub-date pub-type="pmc-release"><day>1</day><month>4</month><year>2010</year></pub-date><pmc-comment> PMC Release delay is 12 months and 0 days and was based on the copyright element. </pmc-comment>
<volume>20</volume><issue>4</issue><fpage>883</fpage><lpage>892</lpage><history><date date-type="received"><day>1</day><month>7</month><year>2008</year></date><date date-type="accepted"><day>29</day><month>10</month><year>2008</year></date></history><permissions><copyright-statement>Copyright © 2009 by the American Society of Nephrology</copyright-statement></permissions><self-uri xlink:title="pdf" xlink:href="asn00409000883.pdf"></self-uri><abstract><p>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% (<italic>P</italic> < 0.0001), which was driven by reduced risks for developing microalbuminuria and macroalbuminuria (both <italic>P</italic> < 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.</p></abstract></article-meta><notes><fn-group><fn><p>Published online ahead of print. Publication date available at <ext-link ext-link-type="uri" xlink:href="www.jasn.org">www.jasn.org</ext-link>.</p></fn><fn><p>This trial has been registered at <ext-link ext-link-type="uri" xlink:href="www.clinicaltrials.gov">www.clinicaltrials.gov</ext-link> (identifier NCT00145925).</p></fn></fn-group></notes></front><floats-wrap><fig position="float" id="f1"><label>Figure 1.</label><caption><p>(A through C) Mean eGFR during follow-up according to treatment assignment in patients with normoalbuminuria (A), microalbuminuria (B), and macroalbuminuria (C) at baseline. R, randomization; Per-Ind, perindopril-indapamide treatment group.</p></caption><graphic xlink:href="asn0040939360001"></graphic></fig><fig position="float" id="f2"><label>Figure 2.</label><caption><p>Effect of randomized treatment on all renal events (top) and the composite of all renal events, macrovascular events, or all-cause mortality (bottom) according to baseline SBP and DBP. The center of the diamond represents the estimate and its width the 95% CI for overall treatment effect. Solid boxes represent estimates of treatment effect in subgroups; the centers of the boxes are placed at the estimates of effect, the areas of boxes are proportional to the number of events, and horizontal lines represent the corresponding 95% CIs. The vertical dotted line represents the point estimate for overall effect. The “P trend” tested the consistency of treatment effect in subgroups.</p></caption><graphic xlink:href="asn0040939360002"></graphic></fig><fig position="float" id="f3"><label>Figure 3.</label><caption><p>Effect of randomized treatment on all renal events in subgroups of participants defined by characteristics at baseline. For other conventions, see <xref rid="f1" ref-type="fig">Figure 1</xref>. <italic>P</italic> > 0.1 for trend for all subgroup comparisons.</p></caption><graphic xlink:href="asn0040939360003"></graphic></fig><fig position="float" id="f4"><label>Figure 4.</label><caption><p>Incidence of all renal events according to achieved BP levels, adjusted for age, gender, duration of diabetes, glycosylated hemoglobin, currently treated hypertension, history of macrovascular disease, electrocardiogram abnormalities (ventricular hypertrophy, Q waves, or atrial fibrillation), triglycerides, LDL cholesterol, HDL cholesterol, body mass index, current smoking, current alcohol use, and study drug. Solid boxes represent estimates of event rates, centers of which are placed at the intersection of the point estimate and median SBP value. Areas of the boxes are proportional to the number of events, and vertical bars represent 95% CI. The rate of all renal events was significantly associated with achieved SBP levels (<italic>P</italic> < 0.0001 for trend).</p></caption><graphic xlink:href="asn0040939360004"></graphic></fig><table-wrap position="float" id="t1"><label>Table 1.</label><caption><p>Baseline characteristics recorded before active run-in<xref ref-type="table-fn" rid="t1fn1">a</xref></p></caption><table frame="hsides" rules="groups"><thead><tr><th colspan="1" rowspan="2" align="center" valign="bottom">Variable</th><th colspan="2" rowspan="1" align="center" valign="bottom">Randomized Treatment
<hr></hr></th></tr><tr><th colspan="1" rowspan="1" align="center" valign="bottom">Perindopril-Indapamide (<italic>n</italic> = 5569)</th><th colspan="1" rowspan="1" align="center" valign="bottom">Placebo (<italic>n</italic> = 5571)</th></tr></thead><tbody><tr><td colspan="1" rowspan="1" align="left" valign="top">Age (yr; mean [SD])</td><td colspan="1" rowspan="1" align="center" valign="top">66 (6)</td><td colspan="1" rowspan="1" align="center" valign="top">66 (7)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top">Female (<italic>n</italic> [%])</td><td colspan="1" rowspan="1" align="center" valign="top">2366 (42.5)</td><td colspan="1" rowspan="1" align="center" valign="top">2369 (42.5)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top">Age when diabetes first diagnosed (yr; mean [SD])</td><td colspan="1" rowspan="1" align="center" valign="top">58 (9)</td><td colspan="1" rowspan="1" align="center" valign="top">58 (9)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top">Duration of diabetes (yr; mean [SD])</td><td colspan="1" rowspan="1" align="center" valign="top">8 (6)</td><td colspan="1" rowspan="1" align="center" valign="top">8 (6)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top">BP control (mmHg; mean [SD])</td><td colspan="1" rowspan="1" align="center" valign="top"></td><td colspan="1" rowspan="1" align="center" valign="top"></td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> SBP</td><td colspan="1" rowspan="1" align="center" valign="top">145 (22)</td><td colspan="1" rowspan="1" align="center" valign="top">145 (21)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> DBP</td><td colspan="1" rowspan="1" align="center" valign="top">81 (11)</td><td colspan="1" rowspan="1" align="center" valign="top">81 (11)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> history of currently treated hypertension (<italic>n</italic> [%])</td><td colspan="1" rowspan="1" align="center" valign="top">3802 (68.3)</td><td colspan="1" rowspan="1" align="center" valign="top">3853 (69.2)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top">Renal parameters</td><td colspan="1" rowspan="1" align="center" valign="top"></td><td colspan="1" rowspan="1" align="center" valign="top"></td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> UACR (μg/mg; median [IQR])</td><td colspan="1" rowspan="1" align="center" valign="top">15 (7 to 40)</td><td colspan="1" rowspan="1" align="center" valign="top">15 (7 to 40)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> microalbuminuria (<italic>n</italic> [%])</td><td colspan="1" rowspan="1" align="center" valign="top">1441 (25.9)</td><td colspan="1" rowspan="1" align="center" valign="top">1421 (25.5)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> macroalbuminuria (<italic>n</italic> [%])<xref ref-type="table-fn" rid="t1fn2">b</xref></td><td colspan="1" rowspan="1" align="center" valign="top">197 (3.5)</td><td colspan="1" rowspan="1" align="center" valign="top">204 (3.7)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> serum creatinine (μmol/L; mean [SD])<xref ref-type="table-fn" rid="t1fn3">c</xref></td><td colspan="1" rowspan="1" align="center" valign="top">87 (23)</td><td colspan="1" rowspan="1" align="center" valign="top">87 (26)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> eGFR (ml/min per 1.73 m<sup>2</sup>; mean [SD])</td><td colspan="1" rowspan="1" align="center" valign="top">78 (25)</td><td colspan="1" rowspan="1" align="center" valign="top">78 (25)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> eGFR <60 ml/min per 1.73 m<sup>2</sup> (<italic>n</italic> [%])</td><td colspan="1" rowspan="1" align="center" valign="top">1063 (19.1)</td><td colspan="1" rowspan="1" align="center" valign="top">1094 (19.6)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top">Previous vascular disease</td><td colspan="1" rowspan="1" align="center" valign="top"></td><td colspan="1" rowspan="1" align="center" valign="top"></td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> history of major macrovascular disease (<italic>n</italic> [%])</td><td colspan="1" rowspan="1" align="center" valign="top">1798 (32.3)</td><td colspan="1" rowspan="1" align="center" valign="top">1792 (32.2)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> history of myocardial infarction (<italic>n</italic> [%])</td><td colspan="1" rowspan="1" align="center" valign="top">678 (12.2)</td><td colspan="1" rowspan="1" align="center" valign="top">656 (11.8)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> history of stroke (<italic>n</italic> [%])</td><td colspan="1" rowspan="1" align="center" valign="top">502 (9.0)</td><td colspan="1" rowspan="1" align="center" valign="top">520 (9.3)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> history of microvascular eye disease (<italic>n</italic> [%])<xref ref-type="table-fn" rid="t1fn4">d</xref></td><td colspan="1" rowspan="1" align="center" valign="top">389 (7.0)</td><td colspan="1" rowspan="1" align="center" valign="top">404 (7.3)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top">Other major risk factors</td><td colspan="1" rowspan="1" align="center" valign="top"></td><td colspan="1" rowspan="1" align="center" valign="top"></td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> current smoker (<italic>n</italic> [%])</td><td colspan="1" rowspan="1" align="center" valign="top">804 (14.4)</td><td colspan="1" rowspan="1" align="center" valign="top">878 (15.8)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> serum total cholesterol (mmol/L; mean [SD])<xref ref-type="table-fn" rid="t1fn5">e</xref></td><td colspan="1" rowspan="1" align="center" valign="top">5.2 (1.2)</td><td colspan="1" rowspan="1" align="center" valign="top">5.2 (1.2)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> serum HDL cholesterol (mmol/L; mean [SD])<xref ref-type="table-fn" rid="t1fn5">e</xref></td><td colspan="1" rowspan="1" align="center" valign="top">1.3 (0.3)</td><td colspan="1" rowspan="1" align="center" valign="top">1.3 (0.4)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> serum HbA<sub>1c</sub> concentration (%; mean [SD])</td><td colspan="1" rowspan="1" align="center" valign="top">7.5 (1.6)</td><td colspan="1" rowspan="1" align="center" valign="top">7.5 (1.6)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> body weight (kg; mean [SD])</td><td colspan="1" rowspan="1" align="center" valign="top">78.3 (16.8)</td><td colspan="1" rowspan="1" align="center" valign="top">78.0 (16.8)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> BMI (kg/m<sup>2</sup>; mean [SD])</td><td colspan="1" rowspan="1" align="center" valign="top">28.3 (5.2)</td><td colspan="1" rowspan="1" align="center" valign="top">28.3 (5.1)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> waist-to-hip ratio (mean [SD])</td><td colspan="1" rowspan="1" align="center" valign="top">0.93 (0.08)</td><td colspan="1" rowspan="1" align="center" valign="top">0.93 (0.08)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top">Region of origin (<italic>n</italic> [%])</td><td colspan="1" rowspan="1" align="center" valign="top"></td><td colspan="1" rowspan="1" align="center" valign="top"></td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> Europe</td><td colspan="1" rowspan="1" align="center" valign="top">2539 (45.6)</td><td colspan="1" rowspan="1" align="center" valign="top">2544 (45.7)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> Asia</td><td colspan="1" rowspan="1" align="center" valign="top">2070 (37.2)</td><td colspan="1" rowspan="1" align="center" valign="top">2066 (37.1)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top">Treatment (<italic>n</italic> [%])</td><td colspan="1" rowspan="1" align="center" valign="top"></td><td colspan="1" rowspan="1" align="center" valign="top"></td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> ACEIs</td><td colspan="1" rowspan="1" align="center" valign="top">2402 (43.1)</td><td colspan="1" rowspan="1" align="center" valign="top">2388 (42.9)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> ARBs</td><td colspan="1" rowspan="1" align="center" valign="top">289 (5.2)</td><td colspan="1" rowspan="1" align="center" valign="top">320 (5.7)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> calcium channel blockers</td><td colspan="1" rowspan="1" align="center" valign="top">1669 (30.0)</td><td colspan="1" rowspan="1" align="center" valign="top">1758 (31.6)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> β blockers</td><td colspan="1" rowspan="1" align="center" valign="top">1344 (24.1)</td><td colspan="1" rowspan="1" align="center" valign="top">1385 (24.9)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> diuretics</td><td colspan="1" rowspan="1" align="center" valign="top">1260 (22.6)</td><td colspan="1" rowspan="1" align="center" valign="top">1247 (22.4)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> antiplatelets</td><td colspan="1" rowspan="1" align="center" valign="top">2597 (46.6)</td><td colspan="1" rowspan="1" align="center" valign="top">2601 (46.7)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> lipid-modifying drugs</td><td colspan="1" rowspan="1" align="center" valign="top">1938 (34.8)</td><td colspan="1" rowspan="1" align="center" valign="top">1996 (35.8)</td></tr></tbody></table><table-wrap-foot><fn id="t1fn1"><label>a</label><p>Reprinted in part from Patel <italic>et al</italic>.,<xref ref-type="bibr" rid="r18">18</xref> with permission from Elsevier. ARB, angiotensin receptor blocker; BMI, body mass index; HbA<sub>1c</sub>, glycosylated hemoglobin; IQR, interquartile range.</p></fn><fn id="t1fn2"><label>b</label><p>UACR >300 μg/mg.</p></fn><fn id="t1fn3"><label>c</label><p>To convert values to mg/dl, divide by 88.4.</p></fn><fn id="t1fn4"><label>d</label><p>Proliferative diabetic retinopathy, retinal photocoagulation therapy, macular edema, or blindness in one eye thought to be caused by diabetes.</p></fn><fn id="t1fn5"><label>e</label><p>To convert values to mg/dl, divide by 0.259.</p></fn></table-wrap-foot></table-wrap><table-wrap position="float" id="t2"><label>Table 2.</label><caption><p>Concomitant BP-lowering treatment at the end of follow-up<xref ref-type="table-fn" rid="t2fn1">a</xref></p></caption><table frame="hsides" rules="groups"><thead><tr><th colspan="1" rowspan="2" align="center" valign="bottom">Variable</th><th colspan="2" rowspan="1" align="center" valign="bottom">End of Follow-up (<italic>n</italic> [%])
<hr></hr></th></tr><tr><th colspan="1" rowspan="1" align="center" valign="bottom">Perindopril-Indapamide</th><th colspan="1" rowspan="1" align="center" valign="bottom">Placebo</th></tr></thead><tbody><tr><td colspan="1" rowspan="1" align="left" valign="top">Open-label perindopril</td><td colspan="1" rowspan="1" align="center" valign="top">2128 (44.5)</td><td colspan="1" rowspan="1" align="center" valign="top">2591 (54.9)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top">Other ACEIs</td><td colspan="1" rowspan="1" align="center" valign="top">232 (4.9)</td><td colspan="1" rowspan="1" align="center" valign="top">213 (4.5)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top">ARBs</td><td colspan="1" rowspan="1" align="center" valign="top">453 (9.5)</td><td colspan="1" rowspan="1" align="center" valign="top">618 (13.1)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top">β blockers</td><td colspan="1" rowspan="1" align="center" valign="top">1492 (31.2)</td><td colspan="1" rowspan="1" align="center" valign="top">1671 (35.4)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top">Calcium antagonists</td><td colspan="1" rowspan="1" align="center" valign="top">1531 (32.0)</td><td colspan="1" rowspan="1" align="center" valign="top">2040 (43.2)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top">Thiazide diuretics</td><td colspan="1" rowspan="1" align="center" valign="top">158 (3.3)</td><td colspan="1" rowspan="1" align="center" valign="top">217 (4.6)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top">Other diuretics</td><td colspan="1" rowspan="1" align="center" valign="top">673 (14.1)</td><td colspan="1" rowspan="1" align="center" valign="top">749 (15.9)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top">Other BP-lowering drugs</td><td colspan="1" rowspan="1" align="center" valign="top">463 (9.7)</td><td colspan="1" rowspan="1" align="center" valign="top">638 (13.5)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top">Any BP-lowering drugs</td><td colspan="1" rowspan="1" align="center" valign="top">3634 (74.0)</td><td colspan="1" rowspan="1" align="center" valign="top">4024 (82.7)</td></tr></tbody></table><table-wrap-foot><fn id="t2fn1"><label>a</label><p>Reprinted from Patel <italic>et al</italic>.,<xref ref-type="bibr" rid="r18">18</xref> with permission from Elsevier.</p></fn></table-wrap-foot></table-wrap><table-wrap position="float" id="t3"><label>Table 3.</label><caption><p>Adjusted risks of end-stage kidney disease, macrovascular events, cardiovascular death, and all-cause death by baseline albuminuria level<xref ref-type="table-fn" rid="t3fn1">a</xref></p></caption><table frame="hsides" rules="groups"><thead><tr><th colspan="1" rowspan="1" align="center" valign="bottom">End Point</th><th colspan="1" rowspan="1" align="center" valign="bottom">Normoalbuminuria (<italic>n</italic> = 7877)</th><th colspan="1" rowspan="1" align="center" valign="bottom">Micro- or Macroalbuminuria (<italic>n</italic> = 3263)</th><th colspan="1" rowspan="1" align="center" valign="bottom">HR (95% CI)</th></tr></thead><tbody><tr><td colspan="1" rowspan="1" align="left" valign="top">End-stage kidney disease<xref ref-type="table-fn" rid="t3fn2">b</xref></td><td colspan="1" rowspan="1" align="center" valign="top">19 (0.2%)</td><td colspan="1" rowspan="1" align="center" valign="top">27 (0.8%)</td><td colspan="1" rowspan="1" align="center" valign="top">1.99 (1.08 to 3.70)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top">Macrovascular events<xref ref-type="table-fn" rid="t3fn3">c</xref></td><td colspan="1" rowspan="1" align="center" valign="top">585 (7.4%)</td><td colspan="1" rowspan="1" align="center" valign="top">415 (12.7%)</td><td colspan="1" rowspan="1" align="center" valign="top">1.61 (1.42 to 1.84)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top">Cardiovascular death</td><td colspan="1" rowspan="1" align="center" valign="top">239 (3.0%)</td><td colspan="1" rowspan="1" align="center" valign="top">229 (7.0%)</td><td colspan="1" rowspan="1" align="center" valign="top">2.07 (1.72 to 2.50)</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top">All-cause death</td><td colspan="1" rowspan="1" align="center" valign="top">496 (6.3%)</td><td colspan="1" rowspan="1" align="center" valign="top">383 (11.7%)</td><td colspan="1" rowspan="1" align="center" valign="top">1.70 (1.48 to 1.96)</td></tr></tbody></table><table-wrap-foot><fn id="t3fn1"><label>a</label><p>Adjusted for age, gender, HbA<sub>1c</sub>, SBP, DBP, LDL cholesterol, HDL cholesterol, triglycerides, BMI, eGFR, current smoking, and current alcohol use.</p></fn><fn id="t3fn2"><label>b</label><p>Defined as requirement of renal replacement therapy or renal death.</p></fn><fn id="t3fn3"><label>c</label><p>Composite of nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death.</p></fn></table-wrap-foot></table-wrap><table-wrap position="float" id="t4"><label>Table 4.</label><caption><p>Incidence of renal end points<xref ref-type="table-fn" rid="t4fn1">a</xref></p></caption><table frame="hsides" rules="groups"><thead><tr><th colspan="1" rowspan="1" align="center" valign="bottom">End Point</th><th colspan="1" rowspan="1" align="center" valign="bottom">Perindopril- Indapamide (No. of Events/Patient [%])</th><th colspan="1" rowspan="1" align="center" valign="bottom">Placebo</th><th colspan="1" rowspan="1" align="center" valign="bottom">HR (95% CI)</th><th colspan="1" rowspan="1" align="center" valign="bottom"><italic>P</italic></th><th colspan="1" rowspan="1" align="center" valign="bottom">NNT</th></tr></thead><tbody><tr><td colspan="1" rowspan="1" align="left" valign="top">Progression of nephropathy</td><td colspan="1" rowspan="1" align="center" valign="top"></td><td colspan="1" rowspan="1" align="center" valign="top"></td><td colspan="1" rowspan="1" align="center" valign="top"></td><td colspan="1" rowspan="1" align="center" valign="top"></td><td colspan="1" rowspan="1" align="center" valign="top"></td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> all renal events</td><td colspan="1" rowspan="1" align="center" valign="top">1243/5569 (22.3)</td><td colspan="1" rowspan="1" align="center" valign="top">1500/5571 (26.9)</td><td colspan="1" rowspan="1" align="center" valign="top">0.79 (0.73 to 0.85)</td><td colspan="1" rowspan="1" align="center" valign="top"><0.0001</td><td colspan="1" rowspan="1" align="center" valign="top">20</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> progression of ≥1 albuminuria stage</td><td colspan="1" rowspan="1" align="center" valign="top">1179/5436 (21.7)</td><td colspan="1" rowspan="1" align="center" valign="top">1442/5412 (26.6)</td><td colspan="1" rowspan="1" align="center" valign="top">0.78 (0.72 to 0.84)</td><td colspan="1" rowspan="1" align="center" valign="top"><0.0001</td><td colspan="1" rowspan="1" align="center" valign="top">18</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> new-onset microalbuminuria</td><td colspan="1" rowspan="1" align="center" valign="top">1094/3995 (27.4)</td><td colspan="1" rowspan="1" align="center" valign="top">1317/3991 (33.0)</td><td colspan="1" rowspan="1" align="center" valign="top">0.79 (0.73 to 0.86)</td><td colspan="1" rowspan="1" align="center" valign="top"><0.0001</td><td colspan="1" rowspan="1" align="center" valign="top">16</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> new-onset macroalbuminuria</td><td colspan="1" rowspan="1" align="center" valign="top">114/5436 (2.1)</td><td colspan="1" rowspan="1" align="center" valign="top">163/5412 (3.0)</td><td colspan="1" rowspan="1" align="center" valign="top">0.69 (0.54 to 0.88)</td><td colspan="1" rowspan="1" align="center" valign="top">0.0027</td><td colspan="1" rowspan="1" align="center" valign="top">97</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> patients with normoalbuminuria</td><td colspan="1" rowspan="1" align="center" valign="top">25/3995 (0.6)</td><td colspan="1" rowspan="1" align="center" valign="top">35/3991 (0.9)</td><td colspan="1" rowspan="1" align="center" valign="top">0.71 (0.42 to 1.18)</td><td colspan="1" rowspan="1" align="center" valign="top">0.1841</td><td colspan="1" rowspan="1" align="center" valign="top">NA</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> patients with microalbuminuria</td><td colspan="1" rowspan="1" align="center" valign="top">89/1441 (6.2)</td><td colspan="1" rowspan="1" align="center" valign="top">128/1421 (9.0)</td><td colspan="1" rowspan="1" align="center" valign="top">0.69 (0.52 to 0.91)</td><td colspan="1" rowspan="1" align="center" valign="top">0.0074</td><td colspan="1" rowspan="1" align="center" valign="top">32</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> doubling of serum creatinine >200 μmol/L</td><td colspan="1" rowspan="1" align="center" valign="top">55/5569 (1.0)</td><td colspan="1" rowspan="1" align="center" valign="top">45/5571 (0.8)</td><td colspan="1" rowspan="1" align="center" valign="top">1.21 (0.81 to 1.79)</td><td colspan="1" rowspan="1" align="center" valign="top">0.3483</td><td colspan="1" rowspan="1" align="center" valign="top">NA</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> end-stage kidney disease<xref ref-type="table-fn" rid="t4fn2">b</xref></td><td colspan="1" rowspan="1" align="center" valign="top">25/5569 (0.4)</td><td colspan="1" rowspan="1" align="center" valign="top">21/5571 (0.4)</td><td colspan="1" rowspan="1" align="center" valign="top">1.18 (0.66 to 2.11)</td><td colspan="1" rowspan="1" align="center" valign="top">0.5736</td><td colspan="1" rowspan="1" align="center" valign="top">NA</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top">Regression of nephropathy</td><td colspan="1" rowspan="1" align="center" valign="top"></td><td colspan="1" rowspan="1" align="center" valign="top"></td><td colspan="1" rowspan="1" align="center" valign="top"></td><td colspan="1" rowspan="1" align="center" valign="top"></td><td colspan="1" rowspan="1" align="center" valign="top"></td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> regression of ≥1 albuminuria stage</td><td colspan="1" rowspan="1" align="center" valign="top">908/1638 (55.4)</td><td colspan="1" rowspan="1" align="center" valign="top">816/1625 (50.2)</td><td colspan="1" rowspan="1" align="center" valign="top">1.16 (1.06 to 1.28)</td><td colspan="1" rowspan="1" align="center" valign="top">0.0017</td><td colspan="1" rowspan="1" align="center" valign="top">19</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> regression to normoalbuminuria</td><td colspan="1" rowspan="1" align="center" valign="top">848/1638 (51.8)</td><td colspan="1" rowspan="1" align="center" valign="top">745/1625 (45.8)</td><td colspan="1" rowspan="1" align="center" valign="top">1.15 (1.04 to 1.27)</td><td colspan="1" rowspan="1" align="center" valign="top">0.0059</td><td colspan="1" rowspan="1" align="center" valign="top">16</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> patients with microalbuminuria</td><td colspan="1" rowspan="1" align="center" valign="top">797/1441 (55.3)</td><td colspan="1" rowspan="1" align="center" valign="top">698/1421 (49.1)</td><td colspan="1" rowspan="1" align="center" valign="top">1.15 (1.04 to 1.27)</td><td colspan="1" rowspan="1" align="center" valign="top">0.0067</td><td colspan="1" rowspan="1" align="center" valign="top">16</td></tr><tr><td colspan="1" rowspan="1" align="left" valign="top"> patients with macroalbuminuria</td><td colspan="1" rowspan="1" align="center" valign="top">51/197 (25.9)</td><td colspan="1" rowspan="1" align="center" valign="top">47/204 (23.0)</td><td colspan="1" rowspan="1" align="center" valign="top">1.08 (0.72 to 1.60)</td><td colspan="1" rowspan="1" align="center" valign="top">0.7146</td><td colspan="1" rowspan="1" align="center" valign="top">NA</td></tr></tbody></table><table-wrap-foot><fn id="t4fn1"><label>a</label><p>NA, not applicable; NNT, number needed to treat to prevent one event of nephropathy progression or to promote one event of nephropathy regression over 5 yr.</p></fn><fn id="t4fn2"><label>b</label><p>Defined as requirement of renal replacement therapy or renal death.</p></fn></table-wrap-foot></table-wrap></floats-wrap></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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