Blood pressure levels in diabetics tied to kidney function decline: Study
Japan: In diabetes patients, mean systolic blood pressure (SBP) is independently associated with the progression to late-stage kidney disease (LSKD), according to findings from an 11.2-year follow-up study. Kidney function
"The findings may become new evidence that for diabetes patients SBP less than 130 mm Hg is recommended to prevent progression to LSKD," Hirofumi Soejima, Health Care Center, Kumamoto University, Kumamoto, Japan, and colleagues wrote in their study published in Heart and Vessels.
There is not much evidence of how blood pressure over 10 years impacts the decline of the estimated glomerular filtration rate (eGFR) in patients with diabetes. The Japanese primary prevention of atherosclerosis with aspirin for diabetes (JPAD) trial was a multicenter, randomized, clinical trial performed from 2002 to 2008. After the trial completion, the researchers' team followed up with the patients until 2019 as a cohort study.
Late-stage kidney disease was defined as eGFR < 30 ml/min/1.73 m2 or hemodialysis. Based on the mean value of systolic blood pressure (SBP) obtained average 7 times during the follow-up, the patients were divided into three groups: a high SBP group (n = 607, SBP ≥ 140 mm Hg); a moderate SBP group (n = 989, 140 > SBP ≥ 130 mm Hg); or a low SBP group (n = 913, SBP < 130 mm Hg).
Based on the study, the researchers found the following:
- There was no significant difference in the mean eGFR among the high SBP, moderate SBP, and low SBP groups on registration.
- The incidence rate of LSKD was significantly higher in the high SBP (HR 2.02) and moderate SBP (HR 1.54) groups than in the low SBP group.
- Cox proportional hazards model analysis revealed that the high SBP (HR, 1.57) and moderate SBP (HR, 1.52) were independent factors after adjustment for proteinuria ≥ ± , age ≥ 65 years, men, body mass index ≥ 24 kg/m2, duration of diabetes ≥ 7.0 years, statin usage, eGFR ≥ 60 ml/min/1.73 m2, hemoglobin A1c ≥ 7.2%, and smoking status.
The authors concluded, "our 11.2-year follow-up study showed that mean SBP was independently associated with the progression to LSKD in diabetic patients."
"These findings may become new evidence that SBP less than 130 mm Hg is recommended for diabetic patients to prevent progression to LSKD."
Reference:
Soejima, H., Ogawa, H., Morimoto, T. et al. Kidney function deterioration is dependent on blood pressure levels: 11.2 year follow-up in diabetic patients. Heart Vessels (2022). https://doi.org/10.1007/s00380-022-02085-0
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