Strict blood pressure control helps kidneys in people with type 1 diabetes

Jack Woodfield
Tue, 22 Nov 2016
Strict blood pressure control helps kidneys in people with type 1 diabetes
A long-term study finds that strict blood pressure control is associated with a reduced risk of kidney damage in people with type 1 diabetes.

Chronic kidney disease is one of the leading causes of decreased mortality in type 1 diabetes, according to scientists at the University of California, San Francisco, who conducted this study.

The researchers compared blood pressure control and kidney health in nearly 1,500 people with type 1 diabetes during a median 24-year period.

Those who had lower blood pressure levels were significantly less likely to develop chronic kidney disease, but the scientists acknowledged that additional research would be needed to prove a causal link.

As part of the study, the researchers monitored the development of macroalbuminuria - an early warning sign for kidney dysfunction - or fully developed kidney disease by the study's end.

The participants with systolic blood pressure below 120 mm Hg had a 41 per cent lower risk of macroalbuminuria and 68 per cent lower risk of chronic kidney disease. Those with a diastolic blood pressure of less than 70 mm Hg had a 27 per cent lesser risk of macroalbuminuria and a 53 per cent lower risk of chronic kidney disease.

Lead author Dr Elaine Ku explained that her team conducted this research to tackle recent recommendations from the American Diabetes Association and NIH Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) to relax aggressive blood pressure targets for people with diabetes.

"We felt it was critical to better understand how blood pressure affects those with type 1 diabetes over the long term," said Ku.

"There's been a lot of research focused on blood pressure, which makes us think we know what we're doing. But in my practice as a nephrologist who sees both children and adults with chronic illnesses, I realise we don't understand how blood pressure impacts people’s health in the long term nearly as well as we should.

"It will take a long-term randomised clinical trial to prove causation, but right now, this cohort is the best dataset I am aware of that allows us to even ask this question. The [US] data suggest the current guidelines are not as strict as they should be for these patients."

The findings of this study appear online in Diabetes Care.
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