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Intensified antihypertensive therapy is associated with improved survival in type 1 diabetic patients with
P T Sawicki1, I Mühlhauser, U Didjurgeit
1Medical Department for Metabolic Diseases and Nutrition (WHO Collaborating Centre for Diabetes), Heinrich-Heine University of Düsseldorf, Germany.
Objective:
To determine the prognosis of treated hypertensive type 1 (insulin-dependent) diabetic patients with overt nephropathy.
Design:
A controlled, prospective, parallel, 5-year follow-up trial.
Setting:
The tertiary care centre of the Heinrich Heine University Hospital in Dusseldorf, Germany.
Patients And Interventions:
A sequential sample of 91 hypertensive patients with overt diabetic nephropathy participated in a diabetes treatment programme. Thereafter 45 patients received intensified antihypertensive therapy including blood pressure self-monitoring and self-adjustment of antihypertensive drug treatment with the goal of permanent normalization of blood pressure values below 140/90 mmHg. The remaining 46 patients were administered routine antihypertensive therapy and formed the control group. At baseline both groups were comparable in age, sex, metabolic control and renal function. The groups differed at baseline in their duration of diabetes and blood pressure values, which were higher in the intensified antihypertensive therapy group.
Outcome Measures:
Total mortality and the need for renal replacement therapy.
Main Results:
Blood pressure control was significantly improved in patients who were subjected to intensified antihypertensive therapy, whereas it deteriorated in the group of patients who received routine antihypertensive therapy. At follow-up, primary end points of the study occurred in five (11%) patients of the intensified therapy group and in 19 (41%) patients of the routine therapy group. According to life table analysis, intensified antihypertensive therapy was associated with less frequent primary end points (P = 0.0058) and longer survival (P = 0.01). The differences between the groups remained significant after adjustment for covariates in the proportional hazards model.
Conclusion:
Participation in a treatment programme aimed at intensification of antihypertensive therapy is associated with a reduction of mortality in hypertensive type 1 diabetic patients with overt nephropathy.