A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
Resistant Hypertension and Risk of Adverse Events in Individuals With Type 1 Diabetes: A Nationwide Prospective Study
Tekijät: Lithovius R, Harjutsalo V, Mutter S, Gordin D, Forsblom C, Groop PH; on behalf of the FinnDiane Study Group
Kustantaja: AMER DIABETES ASSOC
Julkaisuvuosi: 2020
Journal: Diabetes Care
Tietokannassa oleva lehden nimi: DIABETES CARE
Lehden akronyymi: DIABETES CARE
Vuosikerta: 43
Numero: 8
Aloitussivu: 1885
Lopetussivu: 1892
Sivujen määrä: 8
ISSN: 0149-5992
eISSN: 1935-5548
DOI: https://doi.org/10.2337/dc20-0170
Verkko-osoite: https://diabetesjournals.org/care/article/43/8/1885/35526/Resistant-Hypertension-and-Risk-of-Adverse-Events
Tiivistelmä
OBJECTIVE To estimate the risk of diabetic nephropathy (DN) progression, incident coronary heart disease (CHD) and stroke, and all-cause mortality associated with resistant hypertension (RH) in individuals with type 1 diabetes stratified by stages of DN, renal function, and sex. RESEARCH DESIGN AND METHODS This prospective study included a nationally representative cohort of individuals with type 1 diabetes from the Finnish Diabetic Nephropathy Study who had purchases of antihypertensive drugs at (+/- 6 months) baseline visit (1995-2008). Individuals (N= 1,103) were divided into three groups:1) RH,2) uncontrolled blood pressure (BP) but no RH, and3) controlled BP. DN progression, cardiovascular events, and deaths were identified from the individuals' health care records and national registries until 31 December 2015. RESULTS At baseline, 18.7% of the participants had RH, while 23.4% had controlled BP. After full adjustments for clinical confounders, RH was associated with increased risk of DN progression (hazard ratio 1.95 [95% CI 1.37, 2.79],P= 0.0002), while no differences were observed in those with no RH (1.05 [0.76, 1.44],P= 0.8) compared with those who had controlled BP. The risk of incident CHD, incident stroke, and all-cause mortality was higher in individuals with RH compared with those who had controlled BP but not beyond albuminuria and reduced kidney function. Notably, in those with normo- and microalbuminuria, the risk of stroke remained higher in the RH compared with the controlled BP group (3.49 [81.20, 10.15],P= 0.02). CONCLUSIONS Our findings highlight the importance of identifying and providing diagnostic and therapeutic counseling to these very-high-risk individuals with RH.
OBJECTIVE To estimate the risk of diabetic nephropathy (DN) progression, incident coronary heart disease (CHD) and stroke, and all-cause mortality associated with resistant hypertension (RH) in individuals with type 1 diabetes stratified by stages of DN, renal function, and sex. RESEARCH DESIGN AND METHODS This prospective study included a nationally representative cohort of individuals with type 1 diabetes from the Finnish Diabetic Nephropathy Study who had purchases of antihypertensive drugs at (+/- 6 months) baseline visit (1995-2008). Individuals (N= 1,103) were divided into three groups:1) RH,2) uncontrolled blood pressure (BP) but no RH, and3) controlled BP. DN progression, cardiovascular events, and deaths were identified from the individuals' health care records and national registries until 31 December 2015. RESULTS At baseline, 18.7% of the participants had RH, while 23.4% had controlled BP. After full adjustments for clinical confounders, RH was associated with increased risk of DN progression (hazard ratio 1.95 [95% CI 1.37, 2.79],P= 0.0002), while no differences were observed in those with no RH (1.05 [0.76, 1.44],P= 0.8) compared with those who had controlled BP. The risk of incident CHD, incident stroke, and all-cause mortality was higher in individuals with RH compared with those who had controlled BP but not beyond albuminuria and reduced kidney function. Notably, in those with normo- and microalbuminuria, the risk of stroke remained higher in the RH compared with the controlled BP group (3.49 [81.20, 10.15],P= 0.02). CONCLUSIONS Our findings highlight the importance of identifying and providing diagnostic and therapeutic counseling to these very-high-risk individuals with RH.
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