Effects of Intensive Systolic Blood Pressure Lowering on End-Stage Kidney Disease and Kidney Function Decline in Adults With Type 2 Diabetes Mellitus and Cardiovascular Risk Factors: A Post Hoc Analysis of ACCORD-BP and SPRINT
Primary result · Kidney composite outcomeResult — go to the resultHazard ratio 1.35 95% CI 0.85–2.14Authors' conclusion
This post hoc subgroup analysis suggests that intensive SBP lowering does not increase the risk of major adverse kidney events in individuals with T2DM and cardiovascular risk factors.
Study context
- Population
- SPRINT-eligible ACCORD-BP participants with T2D and cardiovascular risk factors in the standard glucose-lowering arm; 40% women, mean age 63 years
- Participants
- 1,966 participants
- Comparison
- Intensive vs standard systolic blood pressure (SBP) lowering
- Primary endpoint
- Kidney composite:
- Dialysis
- Kidney transplant
- Sustained estimated glomerular filtration rate (eGFR) <15 mL/min/1.73 m²
- Serum creatinine >3.3 mg/dL
- Sustained eGFR decline ≥57%
Methodological detailsSPRINT-eligible subgroup, standard glucose-lowering arm
- SPRINT-eligible subgroup
- Standard glucose-lowering arm
Primary result
Kidney composite outcome
Hazard ratio
1.35
95% CI 0.85–2.14
P = 0.20
By group
Intensive
9.5 events per 1,000 person-years
Standard
7.2 events per 1,000 person-years
Intensivevs Standard
HR 1.35 (95% CI 0.85–2.14); P = 0.20
As reported in the abstract
Further findings
Mean achieved SBP after randomization
| Outcome | HR (95% CI) | |
|---|---|---|
| Moderately increased albuminuria | 0.96 (0.76–1.20) | |
| Severely increased albuminuria | 0.92 (0.66–1.28) | |
| 0.512Hazard ratio (log scale) |
Cohort including SPRINT participants with prediabetes
- Including SPRINT participants with prediabetes did not change the overall results
Original publication
Effects of Intensive Systolic Blood Pressure Lowering on End-Stage Kidney Disease and Kidney Function Decline in Adults With Type 2 Diabetes Mellitus and Cardiovascular Risk Factors: A Post Hoc Analysis of ACCORD-BP and SPRINT. Diabetes Care. Published 14 February 2023. doi:10.
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