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Proteinuria modifies the effect of systolic blood pressure on total and cardiovascular disease mortality in patients with type 2 diabetes
Objectives Hypertension and proteinuria are major risk factors for cardiovascular disease (CVD) mortality in patients with type 2 diabetes. Blood pressure (BP) targets have been progressively lowered in these patients to prevent or delay the progression of nephropathy. However, no long‐term populati...
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| Published in: | Journal of internal medicine 2012-12, Vol.272 (6), p.611-619 |
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| Main Authors: | , , , , , |
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| cites | cdi_FETCH-LOGICAL-c4881-b687c21851090d80154860a314174876ec46552b010e2c96b3152c0d432d510d3 |
| container_end_page | 619 |
| container_issue | 6 |
| container_start_page | 611 |
| container_title | Journal of internal medicine |
| container_volume | 272 |
| creator | Vepsäläinen, T. Laakso, M. Kantola, I. Lehto, S. Juutilainen, A. Rönnemaa, T. |
| description | Objectives
Hypertension and proteinuria are major risk factors for cardiovascular disease (CVD) mortality in patients with type 2 diabetes. Blood pressure (BP) targets have been progressively lowered in these patients to prevent or delay the progression of nephropathy. However, no long‐term population‐based studies have been reported on the interaction between BP and proteinuria with respect to total and CVD mortality in patients with type 2 diabetes.
Design
We prospectively followed 881 middle‐aged type 2 diabetic patients, free of CVD events at baseline, for up to 18 years. Participants were categorized into four groups according to baseline systolic BP (150 mg L−1). Cox proportional hazards model was used to estimate the joint association between systolic BP and proteinuria and the risk of mortality.
Results
During follow‐up, 607 patients died including 395 because of CVD. After adjustment for confounding factors, total and CVD mortality were significantly higher in patients with proteinuria and systolic BP |
| doi_str_mv | 10.1111/j.1365-2796.2012.02581.x |
| format | article |
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Hypertension and proteinuria are major risk factors for cardiovascular disease (CVD) mortality in patients with type 2 diabetes. Blood pressure (BP) targets have been progressively lowered in these patients to prevent or delay the progression of nephropathy. However, no long‐term population‐based studies have been reported on the interaction between BP and proteinuria with respect to total and CVD mortality in patients with type 2 diabetes.
Design
We prospectively followed 881 middle‐aged type 2 diabetic patients, free of CVD events at baseline, for up to 18 years. Participants were categorized into four groups according to baseline systolic BP (<130, 130–139, 140–159 and ≥160 mmHg) and further stratified by proteinuria (≤150 or >150 mg L−1). Cox proportional hazards model was used to estimate the joint association between systolic BP and proteinuria and the risk of mortality.
Results
During follow‐up, 607 patients died including 395 because of CVD. After adjustment for confounding factors, total and CVD mortality were significantly higher in patients with proteinuria and systolic BP <130 mmHg compared with those with systolic BP between 130 and 160 mmHg. The prognosis was similar in patients with systolic BP <130 mmHg or ≥160 mmHg. Among patients without proteinuria, systolic BP <130 mmHg was associated with a nonsignificant reduction in mortality.
Conclusions
Type 2 diabetic patients with proteinuria and with systolic BP <130 mmHg may have an increased risk of CVD mortality. The presence of proteinuria should be taken into account when defining the target systolic BP level for the prevention of fatal CVD events in patients with type 2 diabetes.</description><identifier>ISSN: 0954-6820</identifier><identifier>EISSN: 1365-2796</identifier><identifier>DOI: 10.1111/j.1365-2796.2012.02581.x</identifier><identifier>PMID: 22891848</identifier><language>eng</language><publisher>Oxford: Blackwell Publishing Ltd</publisher><subject>Biological and medical sciences ; Blood Pressure ; Blood Pressure Determination ; cardiovascular disease ; Cardiovascular Diseases - etiology ; Cardiovascular Diseases - mortality ; Cardiovascular Diseases - prevention & control ; Confounding Factors (Epidemiology) ; diabetes complications ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - epidemiology ; Diabetes Mellitus, Type 2 - physiopathology ; Diabetes. Impaired glucose tolerance ; Diabetic Nephropathies - complications ; Diabetic Nephropathies - physiopathology ; Effect Modifier, Epidemiologic ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Female ; Finland - epidemiology ; General aspects ; Humans ; Hypertension - complications ; Hypertension - diagnosis ; Hypertension - epidemiology ; Hypertension - physiopathology ; Male ; Medical sciences ; Middle Aged ; Nephrology. Urinary tract diseases ; Proportional Hazards Models ; Prospective Studies ; proteinuria ; Proteinuria - epidemiology ; Proteinuria - etiology ; Risk Factors ; Secondary Prevention - methods ; Secondary Prevention - statistics & numerical data ; systolic blood pressure ; type 2 diabetes ; Urinary system involvement in other diseases. Miscellaneous ; Urinary tract. Prostate gland</subject><ispartof>Journal of internal medicine, 2012-12, Vol.272 (6), p.611-619</ispartof><rights>2012 The Association for the Publication of the Journal of Internal Medicine</rights><rights>2015 INIST-CNRS</rights><rights>2012 The Association for the Publication of the Journal of Internal Medicine.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4881-b687c21851090d80154860a314174876ec46552b010e2c96b3152c0d432d510d3</citedby><cites>FETCH-LOGICAL-c4881-b687c21851090d80154860a314174876ec46552b010e2c96b3152c0d432d510d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26617164$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22891848$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vepsäläinen, T.</creatorcontrib><creatorcontrib>Laakso, M.</creatorcontrib><creatorcontrib>Kantola, I.</creatorcontrib><creatorcontrib>Lehto, S.</creatorcontrib><creatorcontrib>Juutilainen, A.</creatorcontrib><creatorcontrib>Rönnemaa, T.</creatorcontrib><title>Proteinuria modifies the effect of systolic blood pressure on total and cardiovascular disease mortality in patients with type 2 diabetes</title><title>Journal of internal medicine</title><addtitle>J Intern Med</addtitle><description>Objectives
Hypertension and proteinuria are major risk factors for cardiovascular disease (CVD) mortality in patients with type 2 diabetes. Blood pressure (BP) targets have been progressively lowered in these patients to prevent or delay the progression of nephropathy. However, no long‐term population‐based studies have been reported on the interaction between BP and proteinuria with respect to total and CVD mortality in patients with type 2 diabetes.
Design
We prospectively followed 881 middle‐aged type 2 diabetic patients, free of CVD events at baseline, for up to 18 years. Participants were categorized into four groups according to baseline systolic BP (<130, 130–139, 140–159 and ≥160 mmHg) and further stratified by proteinuria (≤150 or >150 mg L−1). Cox proportional hazards model was used to estimate the joint association between systolic BP and proteinuria and the risk of mortality.
Results
During follow‐up, 607 patients died including 395 because of CVD. After adjustment for confounding factors, total and CVD mortality were significantly higher in patients with proteinuria and systolic BP <130 mmHg compared with those with systolic BP between 130 and 160 mmHg. The prognosis was similar in patients with systolic BP <130 mmHg or ≥160 mmHg. Among patients without proteinuria, systolic BP <130 mmHg was associated with a nonsignificant reduction in mortality.
Conclusions
Type 2 diabetic patients with proteinuria and with systolic BP <130 mmHg may have an increased risk of CVD mortality. The presence of proteinuria should be taken into account when defining the target systolic BP level for the prevention of fatal CVD events in patients with type 2 diabetes.</description><subject>Biological and medical sciences</subject><subject>Blood Pressure</subject><subject>Blood Pressure Determination</subject><subject>cardiovascular disease</subject><subject>Cardiovascular Diseases - etiology</subject><subject>Cardiovascular Diseases - mortality</subject><subject>Cardiovascular Diseases - prevention & control</subject><subject>Confounding Factors (Epidemiology)</subject><subject>diabetes complications</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - epidemiology</subject><subject>Diabetes Mellitus, Type 2 - physiopathology</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Diabetic Nephropathies - complications</subject><subject>Diabetic Nephropathies - physiopathology</subject><subject>Effect Modifier, Epidemiologic</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Female</subject><subject>Finland - epidemiology</subject><subject>General aspects</subject><subject>Humans</subject><subject>Hypertension - complications</subject><subject>Hypertension - diagnosis</subject><subject>Hypertension - epidemiology</subject><subject>Hypertension - physiopathology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>proteinuria</subject><subject>Proteinuria - epidemiology</subject><subject>Proteinuria - etiology</subject><subject>Risk Factors</subject><subject>Secondary Prevention - methods</subject><subject>Secondary Prevention - statistics & numerical data</subject><subject>systolic blood pressure</subject><subject>type 2 diabetes</subject><subject>Urinary system involvement in other diseases. Miscellaneous</subject><subject>Urinary tract. Prostate gland</subject><issn>0954-6820</issn><issn>1365-2796</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><recordid>eNqNkcFu1DAURS0EokPhF5A3SGyS2k7iOBskGNFSVCgLaJeWY7-oHjJxajt08gn8dR1mGLZ48yy9c6-texHClOQ0nbNNTgteZaxueM4IZTlhlaD57glaHRdP0Yo0VZlxwcgJehHChhBaEE6eoxPGRENFKVbo9zfvIthh8lbhrTO2sxBwvAMMXQc6YtfhMIfoeqtx2ztn8OghhMkDdgOOLqoeq8Fgrbyx7pcKeuqVx8YGUAGSpU-EjTO2Ax5VtDDEgB9svMNxHgGzRKoWIoSX6Fmn-gCvDvMU_Tj_-H39Kbu6vrhcv7_KdCkEzVouas2oqChpiBGEVqXgRBW0pHUpag665FXFWkIJMN3wtqAV08SUBTNJY4pT9HbvO3p3P0GIcmuDhr5XA7gpSEoFb4qUIk-o2KPauxA8dHL0dqv8LCmRSxFyI5e85ZK3XIqQf4qQuyR9fXhlardgjsK_ySfgzQFIkam-82rQNvzjOKc15WXi3u25B9vD_N8fkJ-vL78s12SQ7Q1siLA7Gij_U_K6qCt5-_VCrht-8-H2nMib4hGUCLPh</recordid><startdate>201212</startdate><enddate>201212</enddate><creator>Vepsäläinen, T.</creator><creator>Laakso, M.</creator><creator>Kantola, I.</creator><creator>Lehto, S.</creator><creator>Juutilainen, A.</creator><creator>Rönnemaa, T.</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201212</creationdate><title>Proteinuria modifies the effect of systolic blood pressure on total and cardiovascular disease mortality in patients with type 2 diabetes</title><author>Vepsäläinen, T. ; Laakso, M. ; Kantola, I. ; Lehto, S. ; Juutilainen, A. ; Rönnemaa, T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4881-b687c21851090d80154860a314174876ec46552b010e2c96b3152c0d432d510d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Biological and medical sciences</topic><topic>Blood Pressure</topic><topic>Blood Pressure Determination</topic><topic>cardiovascular disease</topic><topic>Cardiovascular Diseases - etiology</topic><topic>Cardiovascular Diseases - mortality</topic><topic>Cardiovascular Diseases - prevention & control</topic><topic>Confounding Factors (Epidemiology)</topic><topic>diabetes complications</topic><topic>Diabetes Mellitus, Type 2 - complications</topic><topic>Diabetes Mellitus, Type 2 - epidemiology</topic><topic>Diabetes Mellitus, Type 2 - physiopathology</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Diabetic Nephropathies - complications</topic><topic>Diabetic Nephropathies - physiopathology</topic><topic>Effect Modifier, Epidemiologic</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Female</topic><topic>Finland - epidemiology</topic><topic>General aspects</topic><topic>Humans</topic><topic>Hypertension - complications</topic><topic>Hypertension - diagnosis</topic><topic>Hypertension - epidemiology</topic><topic>Hypertension - physiopathology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>proteinuria</topic><topic>Proteinuria - epidemiology</topic><topic>Proteinuria - etiology</topic><topic>Risk Factors</topic><topic>Secondary Prevention - methods</topic><topic>Secondary Prevention - statistics & numerical data</topic><topic>systolic blood pressure</topic><topic>type 2 diabetes</topic><topic>Urinary system involvement in other diseases. Miscellaneous</topic><topic>Urinary tract. Prostate gland</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vepsäläinen, T.</creatorcontrib><creatorcontrib>Laakso, M.</creatorcontrib><creatorcontrib>Kantola, I.</creatorcontrib><creatorcontrib>Lehto, S.</creatorcontrib><creatorcontrib>Juutilainen, A.</creatorcontrib><creatorcontrib>Rönnemaa, T.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of internal medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vepsäläinen, T.</au><au>Laakso, M.</au><au>Kantola, I.</au><au>Lehto, S.</au><au>Juutilainen, A.</au><au>Rönnemaa, T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Proteinuria modifies the effect of systolic blood pressure on total and cardiovascular disease mortality in patients with type 2 diabetes</atitle><jtitle>Journal of internal medicine</jtitle><addtitle>J Intern Med</addtitle><date>2012-12</date><risdate>2012</risdate><volume>272</volume><issue>6</issue><spage>611</spage><epage>619</epage><pages>611-619</pages><issn>0954-6820</issn><eissn>1365-2796</eissn><abstract>Objectives
Hypertension and proteinuria are major risk factors for cardiovascular disease (CVD) mortality in patients with type 2 diabetes. Blood pressure (BP) targets have been progressively lowered in these patients to prevent or delay the progression of nephropathy. However, no long‐term population‐based studies have been reported on the interaction between BP and proteinuria with respect to total and CVD mortality in patients with type 2 diabetes.
Design
We prospectively followed 881 middle‐aged type 2 diabetic patients, free of CVD events at baseline, for up to 18 years. Participants were categorized into four groups according to baseline systolic BP (<130, 130–139, 140–159 and ≥160 mmHg) and further stratified by proteinuria (≤150 or >150 mg L−1). Cox proportional hazards model was used to estimate the joint association between systolic BP and proteinuria and the risk of mortality.
Results
During follow‐up, 607 patients died including 395 because of CVD. After adjustment for confounding factors, total and CVD mortality were significantly higher in patients with proteinuria and systolic BP <130 mmHg compared with those with systolic BP between 130 and 160 mmHg. The prognosis was similar in patients with systolic BP <130 mmHg or ≥160 mmHg. Among patients without proteinuria, systolic BP <130 mmHg was associated with a nonsignificant reduction in mortality.
Conclusions
Type 2 diabetic patients with proteinuria and with systolic BP <130 mmHg may have an increased risk of CVD mortality. The presence of proteinuria should be taken into account when defining the target systolic BP level for the prevention of fatal CVD events in patients with type 2 diabetes.</abstract><cop>Oxford</cop><pub>Blackwell Publishing Ltd</pub><pmid>22891848</pmid><doi>10.1111/j.1365-2796.2012.02581.x</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of internal medicine, 2012-12, Vol.272 (6), p.611-619 |
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| subjects | Biological and medical sciences Blood Pressure Blood Pressure Determination cardiovascular disease Cardiovascular Diseases - etiology Cardiovascular Diseases - mortality Cardiovascular Diseases - prevention & control Confounding Factors (Epidemiology) diabetes complications Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - epidemiology Diabetes Mellitus, Type 2 - physiopathology Diabetes. Impaired glucose tolerance Diabetic Nephropathies - complications Diabetic Nephropathies - physiopathology Effect Modifier, Epidemiologic Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Female Finland - epidemiology General aspects Humans Hypertension - complications Hypertension - diagnosis Hypertension - epidemiology Hypertension - physiopathology Male Medical sciences Middle Aged Nephrology. Urinary tract diseases Proportional Hazards Models Prospective Studies proteinuria Proteinuria - epidemiology Proteinuria - etiology Risk Factors Secondary Prevention - methods Secondary Prevention - statistics & numerical data systolic blood pressure type 2 diabetes Urinary system involvement in other diseases. Miscellaneous Urinary tract. Prostate gland |
| title | Proteinuria modifies the effect of systolic blood pressure on total and cardiovascular disease mortality in patients with type 2 diabetes |
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