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Table 4 Summary of Interventional Studies in Diabetic Patients Examining Effect of Blood Pressure Control on Kidney Disease Progression

From: Progression of kidney disease in type 2 diabetes – beyond blood pressure control: an observational study

AUTHOR

STUDY POPULATION

STUDY SIZE/ DURATION

RESULTS

Mogensen et al. Br Med J 1982 [6]

Type I DM

Mean BP 162/103

Urinary albumin 3.9 g/d

GFR 86 ml min-1 1.73 m2-1

N = 5

73 month treatment period compared to previous 20–31 month untreated period

BP decreased to 144/95 mmHg with treatment

Rate of decline of GFR decreased from 14.8 to 5.9 ml min-1 yr-1 in treated period

Parving et al. Lancet 1983 [7]

Type I DM

Mean BP 144/97 mmHg

Proteinuria > 0.5 g/d

GFR approx 77 ml min-1 1.73 m2-1

N = 10

39 month treatment period compared to 29 month untreated period

BP decreased to 128/84 mmHg with treatment

Rate of decline of GFR decreased from 0.9 to 0.39 ml min-1 mo-1 in treated period

Bjorck et al. Br Med J 1986 [8]

Type I DM

Mean BP 163/97 mmHg

Mean proteinuria 2.9 g/d

Mean serum Cr 2.1

N = 14

4.8 yrs (2.8 yrs untreated followed by 2 yrs treated with captopril)

BP decreased to 155/94 mmHg with treatment (p < 0.02)

Urinary protein decreased from 2.9 to 2.8 (NS)

Rate of decline of GFR decreased from 10.3 to 5.5 ml min-1 yr-1 (p < 0.02)

Parving et al. Br Med J 1987 [9]

Type I DM

> 200 ug/min albuminuria

BP 143/96 mmHg pre-treatment Mean GFR approx. 103 ml min-1 1.73 m2-1

N = 11

32 mo. untreated followed by 6 yrs treated)

BP decreased to 129/84 mmHg with treatment (p < 0.01)

Albuminuria decreased from 1038 to 504 ug/min (p < 0.01)

Rate of decline of GFR decreased from 0.89 to 0.22 ml-1 min-1 mo-1 during treatment (p < 0.01)

Parving et al. BMJ 1988 [10]

Type I DM treated with captopril or placebo

> 0.3 g/d albumin (mean approx. 0.95)

Baseline BP 146/93 mmHg and 137/95 mmHg in 2 groups, respectively

Serum Cr < 120 μmol/L

GFR mean approx. 97 ml min-1 1.73 m2-1

N = 31

Captopril (N = 18) Control (N = 13)

2.5 yrs

MAP decreased by 8.7 mmHg to 136/85 by captopril; increased by 6.6 mmHg to 145/98 mmHg in controls (p < 0.001) Albumin excretion decreased to 390 ug/min in captopril, increased to 1367 ug/min in controls (p < 0.001)

GFR decline 5.8 ml min-1 yr-1 in captopril vs. 10 ml min-1 yr-1 in controls (p < 0.01)

Sawicki et al J Diabetes Complications 1995 [11]

Type I DM

Proteinuria > 0.5 g/d

Serum Cr < 265 μmol/L

Diabetic retinopathy

BP > 140/90 mmHg or need for BP meds

Intensive treatment including BP self-monitoring with goal BP < 140/90 mmHg (IT) vs. routine treatment (RT)

N ~ 100

5 yrs

Primary study endpoints (need for dialysis or death) decreased in IT group

UKPDS 38 1998 13

Type II DM

Serum Cr < 177 μmol/L

BP <150/85 mmHg vs. < 180/105 mmHg

N = 31 with overt nephropathy (> 300 mg/l albuminuria) 8.4 yrs

Insufficient numbers to determine if BP control benefitted patients with overt nephropathy (P = 0.06)

Trocha et al. J Hypertension 1999 [12]

Type I DM

Proteinuria > 0.5 g/d

Cr < 265 μmol/L

Diabetic retinopathy

BP > 140/90 mmHg or need for BP meds

BP self-monitoring with goal BP < 140/90 (IT) vs. routine care (RT)

N = 91

IT (N = 45)

RT (N = 46)

10 yrs

Primary study endpoints (need for dialysis or death) decreased in IT group

Lewis et al. Am J Kidney Dis 1999 [14]

Type I DM with overt nephropathy

Serum Cr < 354 μmol/L

MAP of 92 mmHg (Group I) vs. 102–107 mmHg (Group II)

N = 129

N = 63 in Group I

N = 66 in Group II

2 yrs

MAP 92 mmHg in Group I vs. 98 in Group II

No significant difference in rate of decline of GFR

Significant decrease in albuminuria in intensive group

Estacio et al. Diabetes Care 2000 [15]

Type II DM

DBP > 90 mmHg

CCr of 76 ml min-1 1.73 m2-1 Randomized to intensive therapy (IT) (DBP < 75 mmHg) or moderate therapy (MT) (DBP 80–89 mmHg)

N = 470 total

N = 83 with overt proteinuria

5 yrs

BP decreased significantly with IT vs. MT (132/78 mmHg vs. 138/86 mmHg)

Pts with overt albuminuria demonstrated a steady decline in creatinine clearance of 5–6 ml min-1 1.73 m2-1 yr-1 throughout the follow-up period in both IT and MT groups (pNS)

  1. *categorical independent variables