Influence of Prediabetes on the Effects of Intensive Systolic Blood Pressure Control on Kidney Events.
Am J Hypertens
; 32(12): 1170-1177, 2019 11 15.
Article
em En
| MEDLINE
| ID: mdl-31257407
ABSTRACT
BACKGROUND:
More than one-third of US adults have prediabetes, which is typically accompanied by hypertension.METHODS:
We examined whether prediabetes modified the effects of intensive systolic blood pressure (SBP) lowering on the incidence of chronic kidney disease (CKD) and acute kidney injury (AKI) events in a post-hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). Diabetes was a SPRINT exclusion criterion. We defined normoglycemia and prediabetes as fasting plasma glucose <100 mg/dl and ≥100 mg/dl, respectively.RESULTS:
Of the 9,323 participants included in this analysis, 3,898 (41.8%) had prediabetes and the rest (5,425) had normoglycemia. In participants with baseline estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m2, incident CKD was defined as a ≥30% decline in eGFR to below 60 ml/min/1.73 m2 with repeat confirmation. AKI events were identified clinically. In the non-CKD participants (n = 6,678), there were 164 incident CKD events. The hazard ratios (HRs) for incident CKD for intensive SBP goal (<120 mm Hg) vs. standard SBP goal (<140 mm Hg) in the normoglycemia (HR 3.25, 95% CI 2.03, 5.19) and prediabetes (HR 3.90, 95% CI 2.17, 7.02) groups were similar (interaction P value 0.64). In the entire analytic cohort (N = 9,323), there were 310 AKI events. AKI HRs for intensive vs. standard SBP in the normoglycemia (HR 1.59, 95% CI 1.17, 2.15) and prediabetes (HR 1.74, 95% CI 1.22, 2.48) groups were also similar (interaction P value 0.71).CONCLUSIONS:
Prediabetes was highly prevalent, but there was no evidence that prediabetes modified the effects of SPRINT intervention on kidney events.CLINICAL TRIALS REGISTRATIONNCT01206062.Palavras-chave
Texto completo:
1
Eixos temáticos:
Pesquisa_clinica
Base de dados:
MEDLINE
Assunto principal:
Estado Pré-Diabético
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Pressão Sanguínea
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Insuficiência Renal Crônica
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Injúria Renal Aguda
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Taxa de Filtração Glomerular
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Hipertensão
/
Rim
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Anti-Hipertensivos
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
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Etiology_studies
/
Incidence_studies
/
Prevalence_studies
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Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
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Aged80
/
Female
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Humans
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Male
/
Middle aged
País como assunto:
America do norte
/
Caribe
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Puerto rico
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article