Lowering blood pressure reduces renal events in type 2 diabetes

Bastiaan E. De Galan, Vlado Perkovic*, Toshiharu Ninomiya, Avinesh Pillai, Anushka Patel, Alan Cass, Bruce Neal, Neil Poulter, Stephen Harrap, Carl Erik Mogensen, Mark Cooper, Michel Marre, Bryan Williams, Pavel Hamet, Giuseppe Mancia, Mark Woodward, Paul Glasziou, Diederick E. Grobbee, Stephen MacMahon, John Chalmers

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

261 Citations (Scopus)


BP is an important determinant of kidney disease among patients with diabetes. The recommended thresholds to initiate treatment to lower BP are 130/80 and 125/75 mmHg for people with diabetes and nephropathy, respectively. We sought to determine the effects of lowering BP below these currently recommended thresholds on renal outcomes among 11,140 patients who had type 2 diabetes and participated in the Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study. Patients were randomly assigned to fixed combination perindopril-indapamide or placebo, regardless of their BP at entry. During a mean follow-up of 4.3 yr, active treatment reduced the risk for renal events by 21% (P < 0.0001), which was driven by reduced risks for developing microalbuminuria and macroalbuminuria (both P < 0.003). Effects of active treatment were consistent across subgroups defined by baseline systolic or diastolic BP. Lower systolic BP levels during follow-up, even to <110 mmHg, was associated with progressively lower rates of renal events. In conclusion, BP-lowering treatment with perindopril-indapamide administered routinely to individuals with type 2 diabetes provides important renoprotection, even among those with initial BP <120/70 mmHg. We could not identify a BP threshold below which renal benefit is lost.

Original languageEnglish
Pages (from-to)883-892
Number of pages10
JournalJournal of the American Society of Nephrology : JASN
Issue number4
Publication statusPublished - Apr 2009
Externally publishedYes


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