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Time in Target Range for Hemoglobin A1c and Systolic Blood Pressure: Association With Adverse Kidney Events
Xi Meng1, Yueyue Wang1, Xiaoyun Zhang1
1Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, China; National Clinical Research Center for Metabolic Diseases (Shanghai), Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, China.
Summary
Maintaining blood glucose and blood pressure within target ranges significantly reduces the risk of adverse kidney outcomes in patients with type 2 diabetes. Longer time in target range for both HbA1c and SBP is linked to better kidney health.
Area of Science:
- Nephrology
- Endocrinology
- Cardiovascular Medicine
Background:
- Time in target range (TTR) for hemoglobin A1c (HbA1c) and systolic blood pressure (SBP) reflects glycemic and pressure control quality over time.
- The combined impact of HbA1c-TTR and SBP-TTR on kidney outcomes remains incompletely understood.
- Type 2 diabetes and hypertension are major risk factors for chronic kidney disease.
Purpose of the Study:
- To investigate the association of HbA1c-TTR and SBP-TTR, both individually and jointly, with kidney outcomes.
- To evaluate the impact of sustained glycemic and blood pressure control on renal health in diabetic patients.
Main Methods:
- A post hoc observational cohort analysis was conducted using data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.
- 6,542 participants with type 2 diabetes and hypertension were included, with HbA1c and SBP measurements analyzed over the first 12 months.
- Cox proportional hazards models were used to assess the association between HbA1c-TTR, SBP-TTR, and a composite kidney outcome (albuminuria, eGFR decline ≥ 40%, or kidney failure).
Main Results:
- Higher HbA1c-TTR (100%) was associated with a 20% lower risk of the composite kidney outcome compared to the lowest tertile (≤49.6%).
- Higher SBP-TTR (100%) was associated with a 32% lower risk of the composite kidney outcome compared to the lowest tertile (≤50.7%).
- Patients achieving both HbA1c-TTR and SBP-TTR > 80% had a 29% lower risk compared to those with both ≤ 80%.
Conclusions:
- Achieving and maintaining target ranges for both HbA1c and SBP over time is associated with a reduced risk of adverse kidney events.
- These findings highlight the importance of long-term glycemic and blood pressure control in preventing kidney disease progression in type 2 diabetes.
- Further research with longer follow-up is warranted to confirm these associations, particularly for kidney failure events.
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