AI Article Synopsis

  • The study investigated the impact of strict blood pressure (BP) control on health outcomes in patients with diabetic kidney disease (DKD), focusing on whether targeting systolic BP (SBP) below 130 mmHg has benefits compared to below 140 mmHg.
  • A total of 341 DKD patients were split into standard and strict BP control groups, with cardiovascular and renal events being monitored over a follow-up period of 2.8 years.
  • Results showed that while strict BP control didn't significantly lower the risk of health events, maintaining achieved SBP levels between 130-139 mmHg was linked to a reduced risk of cardiovascular and renal complications.

Article Abstract

Background: The target blood pressure (BP) value is unclear for diabetic kidney disease (DKD). Therefore, we aimed to evaluate the effect of strict BP control or 'on treatment' BP on clinical outcomes in patients with DKD.

Methods: A post-hoc analysis of the prespecified secondary outcomes of the FimAsartaN proTeinuriA SusTaIned reduCtion in comparison with losartan in diabetic chronic kidney disease (FANTASTIC) trial, a randomized multicenter double-blind phase III trial. Eligible patients were aged ≥ 19 years with DKD. We assigned 341 participants with DKD to BP control strategy (standard-systolic BP [SBP] < 140 mmHg versus strict-SBP < 130 mmHg). The outcome was the occurrence of cardiovascular events and renal events. Separate analyses were performed to compared the risk of outcome according to achieved average BP levels.

Results: A total of 341 participants were included in the analysis. Over a median follow-up of 2.8 years, cardiovascular/renal events were observed in 25 (7.3%) participants. Mean (SD) SBPs in the standard and strict BP control group were 140.2 (11.6) and 140.2 (11.9) mmHg, respectively. The strict BP control group did not show significantly reduced risk of cardiovascular/renal events (HR 1.32; 95% CI 0.60-2.92]). In the post-hoc analyses using achieved BP, achieved average SBP of 130-139 mmHg resulted in reduced risk of cardiovascular/renal events (HR 0.15; 95% CI 0.03-0.67) compared to achieved average SBP ≥ 140 mmHg, whereas further reduction in achieved average SBP < 130 mmHg did not impart additional benefits.

Conclusion: In patients with DKD, targeting a SBP of less than 130 mmHg, as compared with less than 140 mmHg, did not reduce the rate of a composite of cardiovascular and renal events. Achieved SBP of 130-139 mmHg was associated with a decreased risk for the primary outcome in patients with DKD.

Trial Registration: ClinicalTirals.gov Identifier: NCT02620306, registered December 3, 2015. ( https://clinicaltrials.gov/study/NCT02620306 ).

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11293031PMC
http://dx.doi.org/10.1186/s40885-024-00280-xDOI Listing

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