The risk of renal events can be reduced even in patients with systolic pressures below 120 mm Hg.

BP-lowering may provide renoprotection in patients with type 2 diabetes, regardless of baseline BP level.

Researchers analyzed data from 11,140 patients with type 2 diabetes who participated in the Action in Diabetes and Vascular disease: peterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study. BP levels at study entry averaged 145/81 mm Hg overall; 20% of subjects had a BP less than 130/80.

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Patients were randomly assigned to receive fixed combination perindopril-indapamide or placebo, regardless of their BP at study entry.

During a mean follow-up of 4.3 years, the composite renal outcome of new-onset microalbuminuria, new-onset nephropathy, doubling of serum creatinine above 200 µmol/L, or end-stage renal disease developed in 1,243 patients in the active treatment group and 1,500 placebo recipients, according to a report in the Journal of the American Society of Nephrology (2009;20:883-892).

This difference translated into a 21% reduced risk of renal events among patients who received active treatment. On this basis, the researchers noted, one renal event could be prevented for every 20 patients assigned active treatment for a five-year period.

The analysis, led by Vlado Perkovic, MD, PhD, of the George Institute for International Health at the University of Sydney in Australia, revealed a reduced risk of renal events across BP subgroups. Even among patients with the lowest baseline systolic BP (less then 120), active treatment was associated with a statistically significant 22% reduced risk of the composite outcome in patients with normoalbuminuria. “We could not identify a BP threshold below which renal benefit is lost,” the authors concluded.

In addition, active treatment was associated with a 22% reduced risk of progression of albuminuria among subjects who had either normo- or microalbuminuria at baseline, the investigators reported. Among patients with albuminuria, active treatment was associated with a greater likelihood of return to normoalbuminuria.