Cardiovascular outcomes in action to control cardiovascular risk in diabetes

Impact of blood pressure level and presence of kidney disease

Vasilios Papademetriou, Misbah Zaheer, Michael Doumas, Laura Lovato, William B. Applegate, Costas Tsioufis, Amy Mottle, Zubin Punthakee, William Cushman

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Persons with chronic kidney disease (CKD) represent a population prone to cardiovascular disease (CVD) but vulnerable to adverse medication effects. We assessed the impact of intensive antihypertensive therapy on the cerebrovascular and other CVD outcomes in high-risk patients with type 2 diabetes and baseline CKD. Methods: Using current guideline criteria, 1,726 (36.9%) of 4,678 participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure (BP) arm had mild to moderate CKD (CKD1-3B) at baseline. Participants of this study were randomized to intensive (systolic <120 mm Hg) or standard (systolic <140 mm Hg) BP goals. Fatal and non-fatal stroke were pre-specified secondary outcomes of the ACCORD study. Results: Total cerebrovascular events were significantly higher in participants with baseline CKD (0.66%/year) compared with participants free of CKD (0.28%/year). A significantly higher rate of events was observed in CKD participants. Intensive antihypertensive therapy in participants without CKD at baseline resulted in a 55% significant reduction of any stroke (hazard ratio 0.447; 95% CI 0.227-0.880) and a 50% reduction of non-fatal stroke (hazard ratio 0.498; 95% CI 0.250-0.993). In participants with CKD at baseline, the occurrence of any stroke was reduced by 38% (hazard ratio 0.623; 95% CI 0.361-1.074) and non-fatal stroke by 36% (hazard ratio 0.642; 95% CI 0.361-1.142). Test for interaction was NS between the 2 groups. Changes in other CVD outcomes did not reach statistical significance. Conclusions: These findings suggest that intensive antihypertensive therapy offers significant cerebrovascular protection in diabetic participants without CKD at baseline, but significant benefit to patients with CKD cannot be excluded.

Original languageEnglish (US)
Pages (from-to)271-280
Number of pages10
JournalAmerican Journal of Nephrology
Volume43
Issue number4
DOIs
StatePublished - Jun 1 2016

Fingerprint

Kidney Diseases
Chronic Renal Insufficiency
Blood Pressure
Stroke
Antihypertensive Agents
Cardiovascular Diseases
Type 2 Diabetes Mellitus
Therapeutics
Guidelines

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Cardiovascular outcomes in action to control cardiovascular risk in diabetes : Impact of blood pressure level and presence of kidney disease. / Papademetriou, Vasilios; Zaheer, Misbah; Doumas, Michael; Lovato, Laura; Applegate, William B.; Tsioufis, Costas; Mottle, Amy; Punthakee, Zubin; Cushman, William.

In: American Journal of Nephrology, Vol. 43, No. 4, 01.06.2016, p. 271-280.

Research output: Contribution to journalArticle

Papademetriou, V, Zaheer, M, Doumas, M, Lovato, L, Applegate, WB, Tsioufis, C, Mottle, A, Punthakee, Z & Cushman, W 2016, 'Cardiovascular outcomes in action to control cardiovascular risk in diabetes: Impact of blood pressure level and presence of kidney disease', American Journal of Nephrology, vol. 43, no. 4, pp. 271-280. https://doi.org/10.1159/000446122
Papademetriou, Vasilios ; Zaheer, Misbah ; Doumas, Michael ; Lovato, Laura ; Applegate, William B. ; Tsioufis, Costas ; Mottle, Amy ; Punthakee, Zubin ; Cushman, William. / Cardiovascular outcomes in action to control cardiovascular risk in diabetes : Impact of blood pressure level and presence of kidney disease. In: American Journal of Nephrology. 2016 ; Vol. 43, No. 4. pp. 271-280.
@article{8e5ed9b476de4b44800efdf14cc26da9,
title = "Cardiovascular outcomes in action to control cardiovascular risk in diabetes: Impact of blood pressure level and presence of kidney disease",
abstract = "Background: Persons with chronic kidney disease (CKD) represent a population prone to cardiovascular disease (CVD) but vulnerable to adverse medication effects. We assessed the impact of intensive antihypertensive therapy on the cerebrovascular and other CVD outcomes in high-risk patients with type 2 diabetes and baseline CKD. Methods: Using current guideline criteria, 1,726 (36.9{\%}) of 4,678 participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure (BP) arm had mild to moderate CKD (CKD1-3B) at baseline. Participants of this study were randomized to intensive (systolic <120 mm Hg) or standard (systolic <140 mm Hg) BP goals. Fatal and non-fatal stroke were pre-specified secondary outcomes of the ACCORD study. Results: Total cerebrovascular events were significantly higher in participants with baseline CKD (0.66{\%}/year) compared with participants free of CKD (0.28{\%}/year). A significantly higher rate of events was observed in CKD participants. Intensive antihypertensive therapy in participants without CKD at baseline resulted in a 55{\%} significant reduction of any stroke (hazard ratio 0.447; 95{\%} CI 0.227-0.880) and a 50{\%} reduction of non-fatal stroke (hazard ratio 0.498; 95{\%} CI 0.250-0.993). In participants with CKD at baseline, the occurrence of any stroke was reduced by 38{\%} (hazard ratio 0.623; 95{\%} CI 0.361-1.074) and non-fatal stroke by 36{\%} (hazard ratio 0.642; 95{\%} CI 0.361-1.142). Test for interaction was NS between the 2 groups. Changes in other CVD outcomes did not reach statistical significance. Conclusions: These findings suggest that intensive antihypertensive therapy offers significant cerebrovascular protection in diabetic participants without CKD at baseline, but significant benefit to patients with CKD cannot be excluded.",
author = "Vasilios Papademetriou and Misbah Zaheer and Michael Doumas and Laura Lovato and Applegate, {William B.} and Costas Tsioufis and Amy Mottle and Zubin Punthakee and William Cushman",
year = "2016",
month = "6",
day = "1",
doi = "10.1159/000446122",
language = "English (US)",
volume = "43",
pages = "271--280",
journal = "American Journal of Nephrology",
issn = "0250-8095",
publisher = "S. Karger AG",
number = "4",

}

TY - JOUR

T1 - Cardiovascular outcomes in action to control cardiovascular risk in diabetes

T2 - Impact of blood pressure level and presence of kidney disease

AU - Papademetriou, Vasilios

AU - Zaheer, Misbah

AU - Doumas, Michael

AU - Lovato, Laura

AU - Applegate, William B.

AU - Tsioufis, Costas

AU - Mottle, Amy

AU - Punthakee, Zubin

AU - Cushman, William

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Background: Persons with chronic kidney disease (CKD) represent a population prone to cardiovascular disease (CVD) but vulnerable to adverse medication effects. We assessed the impact of intensive antihypertensive therapy on the cerebrovascular and other CVD outcomes in high-risk patients with type 2 diabetes and baseline CKD. Methods: Using current guideline criteria, 1,726 (36.9%) of 4,678 participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure (BP) arm had mild to moderate CKD (CKD1-3B) at baseline. Participants of this study were randomized to intensive (systolic <120 mm Hg) or standard (systolic <140 mm Hg) BP goals. Fatal and non-fatal stroke were pre-specified secondary outcomes of the ACCORD study. Results: Total cerebrovascular events were significantly higher in participants with baseline CKD (0.66%/year) compared with participants free of CKD (0.28%/year). A significantly higher rate of events was observed in CKD participants. Intensive antihypertensive therapy in participants without CKD at baseline resulted in a 55% significant reduction of any stroke (hazard ratio 0.447; 95% CI 0.227-0.880) and a 50% reduction of non-fatal stroke (hazard ratio 0.498; 95% CI 0.250-0.993). In participants with CKD at baseline, the occurrence of any stroke was reduced by 38% (hazard ratio 0.623; 95% CI 0.361-1.074) and non-fatal stroke by 36% (hazard ratio 0.642; 95% CI 0.361-1.142). Test for interaction was NS between the 2 groups. Changes in other CVD outcomes did not reach statistical significance. Conclusions: These findings suggest that intensive antihypertensive therapy offers significant cerebrovascular protection in diabetic participants without CKD at baseline, but significant benefit to patients with CKD cannot be excluded.

AB - Background: Persons with chronic kidney disease (CKD) represent a population prone to cardiovascular disease (CVD) but vulnerable to adverse medication effects. We assessed the impact of intensive antihypertensive therapy on the cerebrovascular and other CVD outcomes in high-risk patients with type 2 diabetes and baseline CKD. Methods: Using current guideline criteria, 1,726 (36.9%) of 4,678 participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure (BP) arm had mild to moderate CKD (CKD1-3B) at baseline. Participants of this study were randomized to intensive (systolic <120 mm Hg) or standard (systolic <140 mm Hg) BP goals. Fatal and non-fatal stroke were pre-specified secondary outcomes of the ACCORD study. Results: Total cerebrovascular events were significantly higher in participants with baseline CKD (0.66%/year) compared with participants free of CKD (0.28%/year). A significantly higher rate of events was observed in CKD participants. Intensive antihypertensive therapy in participants without CKD at baseline resulted in a 55% significant reduction of any stroke (hazard ratio 0.447; 95% CI 0.227-0.880) and a 50% reduction of non-fatal stroke (hazard ratio 0.498; 95% CI 0.250-0.993). In participants with CKD at baseline, the occurrence of any stroke was reduced by 38% (hazard ratio 0.623; 95% CI 0.361-1.074) and non-fatal stroke by 36% (hazard ratio 0.642; 95% CI 0.361-1.142). Test for interaction was NS between the 2 groups. Changes in other CVD outcomes did not reach statistical significance. Conclusions: These findings suggest that intensive antihypertensive therapy offers significant cerebrovascular protection in diabetic participants without CKD at baseline, but significant benefit to patients with CKD cannot be excluded.

UR - http://www.scopus.com/inward/record.url?scp=84973869891&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84973869891&partnerID=8YFLogxK

U2 - 10.1159/000446122

DO - 10.1159/000446122

M3 - Article

VL - 43

SP - 271

EP - 280

JO - American Journal of Nephrology

JF - American Journal of Nephrology

SN - 0250-8095

IS - 4

ER -