Blood pressure control in diabetic kidney disease: a post-hoc analysis of the FANTASTIC trial.

IF 2.6 Q2 PERIPHERAL VASCULAR DISEASE Clinical Hypertension Pub Date : 2024-08-01 DOI:10.1186/s40885-024-00280-x

Cheol Ho Park, Soon Jun Hong, Sung Gyun Kim, Seok Joon Shin, Dong Ki Kim, Jung Pyo Lee, Sang Youb Han, Sangho Lee, Jong Chul Won, Young Sun Kang, Jongha Park, Byoung-Geun Han, Ki-Ryang Na, Kyu Yeon Hur, Yong-Jin Kim, Sungha Park, Tae-Hyun Yoo

{"title":"Blood pressure control in diabetic kidney disease: a post-hoc analysis of the FANTASTIC trial.","authors":"Cheol Ho Park, Soon Jun Hong, Sung Gyun Kim, Seok Joon Shin, Dong Ki Kim, Jung Pyo Lee, Sang Youb Han, Sangho Lee, Jong Chul Won, Young Sun Kang, Jongha Park, Byoung-Geun Han, Ki-Ryang Na, Kyu Yeon Hur, Yong-Jin Kim, Sungha Park, Tae-Hyun Yoo","doi":"10.1186/s40885-024-00280-x","DOIUrl":null,"url":null,"abstract":"Background: The target blood pressure (BP) value is unclear for diabetic kidney disease (DKD). Therefore, we aimed to evaluate the effect of strict BP control or 'on treatment' BP on clinical outcomes in patients with DKD.Methods: A post-hoc analysis of the prespecified secondary outcomes of the FimAsartaN proTeinuriA SusTaIned reduCtion in comparison with losartan in diabetic chronic kidney disease (FANTASTIC) trial, a randomized multicenter double-blind phase III trial. Eligible patients were aged ≥ 19 years with DKD. We assigned 341 participants with DKD to BP control strategy (standard-systolic BP [SBP] < 140 mmHg versus strict-SBP < 130 mmHg). The outcome was the occurrence of cardiovascular events and renal events. Separate analyses were performed to compared the risk of outcome according to achieved average BP levels.Results: A total of 341 participants were included in the analysis. Over a median follow-up of 2.8 years, cardiovascular/renal events were observed in 25 (7.3%) participants. Mean (SD) SBPs in the standard and strict BP control group were 140.2 (11.6) and 140.2 (11.9) mmHg, respectively. The strict BP control group did not show significantly reduced risk of cardiovascular/renal events (HR 1.32; 95% CI 0.60-2.92]). In the post-hoc analyses using achieved BP, achieved average SBP of 130-139 mmHg resulted in reduced risk of cardiovascular/renal events (HR 0.15; 95% CI 0.03-0.67) compared to achieved average SBP ≥ 140 mmHg, whereas further reduction in achieved average SBP < 130 mmHg did not impart additional benefits.Conclusion: In patients with DKD, targeting a SBP of less than 130 mmHg, as compared with less than 140 mmHg, did not reduce the rate of a composite of cardiovascular and renal events. Achieved SBP of 130-139 mmHg was associated with a decreased risk for the primary outcome in patients with DKD.Trial registration: ClinicalTirals.gov Identifier: NCT02620306, registered December 3, 2015. ( https://clinicaltrials.gov/study/NCT02620306 ).","PeriodicalId":10480,"journal":{"name":"Clinical Hypertension","volume":"30 1","pages":"20"},"PeriodicalIF":2.6000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11293031/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Hypertension","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s40885-024-00280-x","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}

引用次数: 0

Abstract

Background: The target blood pressure (BP) value is unclear for diabetic kidney disease (DKD). Therefore, we aimed to evaluate the effect of strict BP control or 'on treatment' BP on clinical outcomes in patients with DKD.

Methods: A post-hoc analysis of the prespecified secondary outcomes of the FimAsartaN proTeinuriA SusTaIned reduCtion in comparison with losartan in diabetic chronic kidney disease (FANTASTIC) trial, a randomized multicenter double-blind phase III trial. Eligible patients were aged ≥ 19 years with DKD. We assigned 341 participants with DKD to BP control strategy (standard-systolic BP [SBP] < 140 mmHg versus strict-SBP < 130 mmHg). The outcome was the occurrence of cardiovascular events and renal events. Separate analyses were performed to compared the risk of outcome according to achieved average BP levels.

Results: A total of 341 participants were included in the analysis. Over a median follow-up of 2.8 years, cardiovascular/renal events were observed in 25 (7.3%) participants. Mean (SD) SBPs in the standard and strict BP control group were 140.2 (11.6) and 140.2 (11.9) mmHg, respectively. The strict BP control group did not show significantly reduced risk of cardiovascular/renal events (HR 1.32; 95% CI 0.60-2.92]). In the post-hoc analyses using achieved BP, achieved average SBP of 130-139 mmHg resulted in reduced risk of cardiovascular/renal events (HR 0.15; 95% CI 0.03-0.67) compared to achieved average SBP ≥ 140 mmHg, whereas further reduction in achieved average SBP < 130 mmHg did not impart additional benefits.

Conclusion: In patients with DKD, targeting a SBP of less than 130 mmHg, as compared with less than 140 mmHg, did not reduce the rate of a composite of cardiovascular and renal events. Achieved SBP of 130-139 mmHg was associated with a decreased risk for the primary outcome in patients with DKD.

Trial registration: ClinicalTirals.gov Identifier: NCT02620306, registered December 3, 2015. ( https://clinicaltrials.gov/study/NCT02620306 ).

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

糖尿病肾病患者的血压控制：FANTASTIC 试验的事后分析。

背景：糖尿病肾病（DKD）的目标血压（BP）值尚不明确。因此，我们旨在评估严格控制血压或 "治疗中 "血压对 DKD 患者临床预后的影响：FimAsartaN proTeinuriA SusTaIned ReduCtion in comparison with losartan in diabetic chronic kidney disease (FANTASTIC)试验是一项随机多中心双盲 III 期试验，我们对该试验预设的次要结果进行了事后分析。符合条件的糖尿病慢性肾病患者年龄≥ 19 岁。我们将 341 名 DKD 患者分配到血压控制策略（标准收缩压 [SBP] 结果）中：共有 341 名患者纳入分析。在中位 2.8 年的随访期间，有 25 人（7.3%）发生了心血管/肾脏事件。标准血压控制组和严格血压控制组的平均（标度）SBP 分别为 140.2 (11.6) mmHg 和 140.2 (11.9) mmHg。严格血压控制组发生心血管/肾脏事件的风险没有明显降低（HR 1.32；95% CI 0.60-2.92]）。在使用达标血压进行的事后分析中，与达标平均血压≥ 140 mmHg 相比，达标平均血压 130-139 mmHg 可降低心血管/肾脏事件风险（HR 0.15；95% CI 0.03-0.67），而进一步降低达标平均血压则可降低心血管/肾脏事件风险：在 DKD 患者中，与低于 140 mmHg 的目标 SBP 相比，目标 SBP 低于 130 mmHg 并不能降低心血管和肾脏综合事件的发生率。SBP达到130-139毫米汞柱与DKD患者主要结局风险的降低有关：试验注册：ClinicalTirals.gov Identifier：NCT02620306，2015年12月3日注册。( https://clinicaltrials.gov/study/NCT02620306 )。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊