Creatinine Rise During Blood Pressure Therapy and the Risk of Adverse Clinical Outcomes in Patients With Type 2 Diabetes Mellitus.
Pubmed ID: 30571235
Journal: Hypertension (Dallas, Tex. : 1979)
Publication Date: 12/01/2018
Affiliation: From the Department of Vascular Medicine (D.C., B.-J.H.v.d.B.), Academic Medical Center, University of Amsterdam, The Netherlands.
MeSH Terms: Humans, Male, Female, Aged, Middle Aged, Hypertension, Treatment Outcome, Creatinine, Diabetes Mellitus, Type 2, Antihypertensive Agents, Blood Pressure Determination
Authors: Brouwer TF, van den Born BH, Collard D, Peters RJG, Vogt L
Cite As: Collard D, Brouwer TF, Peters RJG, Vogt L, van den Born BH. Creatinine Rise During Blood Pressure Therapy and the Risk of Adverse Clinical Outcomes in Patients With Type 2 Diabetes Mellitus. Hypertension 2018 Dec;72(6):1337-1344.
Lowering blood pressure may affect renal function. Current guidelines state that reducing antihypertensive therapy should be considered in patients with a >30% serum creatinine increase after initiation of antihypertensive therapy. We examined the association between a serum creatinine increase and adverse clinical outcomes in the ACCORD-BP trial (Action to Control Cardiovascular Risk in Diabetes Blood Pressure), were patients with type 2 diabetes mellitus were randomized to intensive (target systolic blood pressure <120 mm Hg) and standard antihypertensive (<140 mm Hg) treatment. The primary outcome was a combined end point consisting of all-cause mortality, major cardiovascular events, and renal failure. Patients were stratified into 3 groups according to serum creatinine increase between baseline and 4 months (<10%, 10%-30%, >30%). A total of 4733 patients, aged 62.2 years, 52% men with a mean estimated glomerular filtration rate 81.5 mL/min per 1.73 m<sup>2</sup> were included. Follow-up was available for 4446 patients, 2231 were randomized to intensive and 2215 to standard therapy. Kaplan-Meier analysis showed no association between a serum creatinine increase and the composite end point in the intensive ( P=0.20) and the standard treatment group ( P=0.17). After adjusting for possible confounders, a >30% serum creatinine increase was associated with a higher risk of clinical adverse outcomes in both treatment groups, but to a similar extent. These data suggest that a >30% serum creatinine increase that coincides with lower blood pressure values should not directly lead to a reduction in antihypertensive medication in patients with type 2 diabetes mellitus. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT00000620.