Influence of Prediabetes on the Effects of Intensive Systolic Blood Pressure Control on Kidney Events

Rathi, Naveen; Chertow, Glenn M.; Cushman, William C.; Cheung, Alfred K.; Wei, Guo; Boucher, Robert; Kimmel, Paul L.; Bress, Adam P.; Kramer, Holly; Al-Marji, Catreena; Greene, Tom; Beddhu, Srinivasan

doi:10.1093/ajh/hpz105

Cited by 2 publications

(5 citation statements)

References 39 publications

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“… 9 , 10 Furthermore, our finding regarding the risk of renal disease progression is consistent with the lack of an increased risk of nephropathy in patients with prediabetes who do not have heart failure. 14 , 15 Taken collectively, these observations highlight the importance of distinguishing between diabetes and prediabetes in the prediction of end-organ injury, even in patients with heart failure and a reduced ejection fraction.…”

Section: Discussionmentioning

confidence: 91%

Effect of Empagliflozin on Cardiovascular and Renal Outcomes in Patients With Heart Failure by Baseline Diabetes Status

et al. 2021

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Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve outcomes in patients with heart failure with reduced ejection fraction, but additional information is needed about whether glycemic status influences the magnitude of their benefits on heart failure and renal events. Methods: Patients with class II-IV heart failure and a left ventricular ejection fraction ≤40% were randomized to receive empagliflozin (10 mg daily) or placebo in addition to recommended therapy. We prespecified a comparison of the effect of empagliflozin in patients with and without diabetes. Results: Of the 3730 patients enrolled, 1856 (50%) had diabetes, 1268 (34%) had prediabetes (HbA1c 5.7-6.4%), and 606 (16%) had normoglycemia (HbA1c <5.7%). The risks of the primary outcome (cardiovascular death or hospitalization for heart failure), total hospitalizations for heart failure, and adverse renal outcomes were higher in patients with diabetes, but were similar between patients with prediabetes and normoglycemia. Empagliflozin reduced the risk of the primary outcome in patients with and without diabetes (hazard ratio 0.72 [95% CI 0.60-0.87] and 0.78 [95% CI 0.64-0.97], respectively, interaction P =0.57). Patients with and without diabetes also did not differ with respect to the effect of empagliflozin on total hospitalizations for heart failure, on the decline in estimated glomerular filtration rate over time, and on the risk of serious adverse renal outcomes. Among these endpoints, the effects of the drug did not differ in patients with prediabetes or normoglycemia. When analyzed as a continuous variable, baseline HbA1c did not significantly modify the benefits of empagliflozin on the primary outcome (P-interaction=0.40). Empagliflozin did not lower HbA1c in patients with prediabetes or normoglycemia and was not associated with increased risk of hypoglycemia. Conclusions: In the EMPEROR-Reduced trial, empagliflozin significantly improved cardiovascular and renal outcomes in patients with heart failure and a reduced ejection fraction, independent of baseline diabetes status and across the continuum of HbA1c.

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Section: Discussionmentioning

confidence: 91%

Effect of Empagliflozin on Cardiovascular and Renal Outcomes in Patients With Heart Failure by Baseline Diabetes Status

et al. 2021

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“…Our study lends the supports to the results of clinical trials among normoglycemia to a certain extent, and it may be more beneficial for CKD prevention and treatment when BP reaches stage 1 hypertension, particularly in prediabetes individuals with BMI < 24 kg/m 2 . At the same time, research shows that the presence of prediabetes did not appear to augment the risk for kidney events during intensive SBP lowering 18 . Our results in prediabetes may provide a new target for early prevention and control of CKD.…”

Section: Discussionmentioning

confidence: 47%

“…At the same time, research shows that the presence of prediabetes did not appear to augment the risk for kidney events during intensive SBP lowering. 18 Our results in prediabetes may provide a new target for early prevention and control of CKD. This result was not obvious when we divided BP levels into five groups, but RCS analysis indicated the risk of incident CKD was relatively flat until BP ≥ 130/80 mmHg and then started to increase rapidly afterwards.…”

Section: Discussionmentioning

confidence: 74%

“… 17 Meanwhile, the impact of prediabetes on the effects of BP control on kidney events also remained uncertain. 18 Therefore, it is necessary to investigate how BP levels of 130–139/80–89 mmHg affect CKD risks with different glycemic status.…”

Section: Introductionmentioning

confidence: 99%

“…However, a recent study reported intensive lowering of BP increased incident CKD risk in individuals with and without type 2 diabetes 17 . Meanwhile, the impact of prediabetes on the effects of BP control on kidney events also remained uncertain 18 . Therefore, it is necessary to investigate how BP levels of 130–139/80–89 mmHg affect CKD risks with different glycemic status.…”

Section: Introductionmentioning

confidence: 99%

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Association of blood pressure and long‐term change with chronic kidney disease risk among Chinese adults with different glucose metabolism according to the 2017 ACC/AHA guidelines

Wang

et al. 2021

J of Clinical Hypertension

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Whether the definition of hypertension according to 2017 AHA/ACC guidelines and blood pressure (BP) changes was related to the increased risk of chronic kidney disease (CKD) remained debated. This prospective cohort study aimed to investigate the association of BP and long‐term BP change with CKD risk with different glucose metabolism according to the new hypertension guidelines. This study examined 12 951 participants and 11 183 participants derived from the older people cohort study, respectively. Participants were divided into three groups based on blood glucose and the risks were assessmented by the logistic regression model. During a 10 years of follow‐up period, 2727 individuals developed CKD (21.1%). Compared with those with BP < 130/80 mmHg, individuals with increased BP levels had significantly increased risk of incident CKD. Participants with BP of 130–139/80–89 or ≥140/90 mmHg had 1.51‐ and 1.89‐fold incident risk of CKD in patients with diabetes mellitus (DM). Compared with individuals with stable BP (−5 to 5 mmHg), the risk of CKD was reduced when BP decreased by 5 mmHg or more and increased when BP increased ≥5 mmHg among normoglycemia and prediabetes participants. Similar results were observed for rapid estimated glomerular filtration rate (eGFR) decline. In conclusion, the BP of 130–139/80–89 mmHg combined with prediabetes or DM had an increased risk of incident CKD and rapid eGFR decline in older people. Long‐term changes of BP by more than 5 mmHg among normoglycemia or prediabetes were associated with the risk of incident CKD and rapid eGFR decline.

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Influence of Prediabetes on the Effects of Intensive Systolic Blood Pressure Control on Kidney Events

Cited by 2 publications

References 39 publications

Effect of Empagliflozin on Cardiovascular and Renal Outcomes in Patients With Heart Failure by Baseline Diabetes Status

Effect of Empagliflozin on Cardiovascular and Renal Outcomes in Patients With Heart Failure by Baseline Diabetes Status

Association of blood pressure and long‐term change with chronic kidney disease risk among Chinese adults with different glucose metabolism according to the 2017 ACC/AHA guidelines

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