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Combined intensive blood pressure and glycemic control does not produce an additive benefit on microvascular outcomes

Faramarz Ismail-Beigi1, Timothy E Craven, Patrick J O'Connor

  • 1Case Western Reserve University, and Cleveland VA Medical Center, Cleveland, Ohio 44106-4951, USA. fxi2@case.edu

Kidney International
|December 15, 2011
PubMed

Insights

Intensive blood pressure control in older adults with type 2 diabetes reduced microalbuminuria, while intensive glycemic control helped macroalbuminuria. Combined intensive treatments showed no additional benefit for microvascular complications.

Area of Science:

  • Endocrinology
  • Nephrology
  • Cardiology

Background:

  • Type 2 diabetes and hypertension often coexist, increasing microvascular complication risks.
  • Controlling blood pressure and glycemia are known to mitigate some diabetes-related complications.

Purpose of the Study:

  • To investigate the combined effects of intensive blood pressure and glycemic control on microvascular complications in older adults with type 2 diabetes and hypertension.
  • To determine if simultaneous intensive management offers additional benefits beyond individual control strategies.

Main Methods:

  • A randomized controlled trial involving 4733 older adults with type 2 diabetes and hypertension.
  • Participants were assigned to either intensive (SBP <120 mmHg) or standard (SBP <140 mmHg) blood pressure control.
  • Participants were also assigned to intensive (HbA1c <6.0%) or standard (HbA1c 7.0-7.9%) glycemic control.

Main Results:

  • Intensive blood pressure control significantly reduced microalbuminuria (HR 0.84) but not other prespecified microvascular outcomes.
  • Intensive glycemic control reduced macroalbuminuria and some other microvascular outcomes.
  • No significant interaction was found between blood pressure and glycemic control; combined intensive treatment did not yield additional benefits.

Conclusions:

  • In older adults with type 2 diabetes and hypertension, intensive blood pressure control offers limited benefits, primarily reducing microalbuminuria.
  • Intensive glycemic control shows some efficacy in reducing specific microvascular outcomes like macroalbuminuria.
  • Simultaneous intensive management of both blood pressure and glycemia does not provide additive protection against microvascular complications.

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