After a mean follow-up of 4.9 years, 306 of the subjects developed an event in the intensive treatment group compared with 333 in the standard treatment group. In the standard treatment group, visits were in month 1, month 4, and every 4 months thereafter. ), Academic Medical Center, University of Amsterdam, The Netherlands. At each visit, BP mediation could be titrated or switched to reach the target SBP according to the protocol. Unauthorized *Only for patients without a history of cardiovascular disease. In the secondary outcome analysis, a serum creatinine increase was associated with an increased hazard ratio for all-cause mortality and cardiovascular mortality in the intensive treatment group, while in the standard treatment group, no such association was found. ... Two types of blood pressure-lowering medications, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), may be effective in slowing the progression of kidney disease. can statins cause elevated creatinine levels. Our results show that, when stratified to initial serum creatinine increase, intensive BP treatment does not lead to an increased risk of adverse clinical outcomes compared with standard therapy in patients with type 2 diabetes mellitus. The results of the Cox-regression using the fully adjusted model for the primary and secondary outcomes are shown in Table II in the online-only Data Supplement. During the first year, at 4 months intervals, serum creatinine was determined, after this information was obtained on yearly basis. Figure 1. Take your blood pressure medications every day as directed. Correspondence to Bert-Jan H. van den Born, Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands. Due to her work at the hospital, she has experience in joint commission hospital accreditation practices. Department of Nephrology (L.V. At the last study visit, delta SBP with baseline and the use of ACE inhibitors or ARBs remained similar, with a difference of −22.1 and −12.3 mm Hg between the intensive and standard treatment group in the >30% stratum and an 89.6% and 83.6% use of ACE inhibitors or ARBs. A previous analysis of the ONTARGET (Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial) and TRANSCEND trial (Telmisartan Randomized Assessment Study in ACE Intolerant Participants With Cardiovascular Disease) showed an increased risk of adverse renal and cardiovascular outcomes in patients with a >12.7% decrease in renal function after treatment with an ACE inhibitor or ARB.22 A similar finding was also observed in a recent study, which showed that a serum creatinine increase larger than 10% after initiation of an ACE inhibitor or ARB was associated with increased cardiorenal and mortality risk in a UK primary care population.11 The results from the present study confirm these findings by showing that a serum creatinine increase of >30% is associated with a higher risk of cardiorenal events and death. This post hoc analysis of the ACCORD-BP trial (Action to Control Cardiovascular Risk in Diabetes Blood Pressure) shows that when stratified to serum creatinine increase intensive antihypertensive treatment does not lead to a higher risk of adverse clinical outcomes compared with standard therapy in patients with type 2 diabetes mellitus. Renal function was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula, taking ethnicity into account.19 Use of medication was determined from the ACCORD-BP trial medication logbook. Blood pressure lowering in type 2 diabetes: a systematic review and meta-analysis. Albuminuria and kidney function independently predict cardiovascular and renal outcomes in diabetes. The figures were created using Graphpad Prism, version 7 (California). Similar, an analysis of acute kidney injury in the SPRINT trial by Rocco et al24 showed an increased risk for acute kidney injury in the intensive compared with the standard treatment group. This is based on studies showing that an initial serum creatinine increase during antihypertensive therapy is associated with an increased risk for all-cause mortality, cardiovascular events, and renal failure. The online-only Data Supplement is available with this article at https://www.ahajournals.org/doi/suppl/10.1161/HYPERTENSIONAHA.118.11944. She received a degree in English from the University of New Hampshire. KDIGO clinical practice guideline for the mnagement of blood pressure in chronic kidney disease. Most patients received an ACE inhibitor or ARB as part of their BP-lowering treatment, but the choice of medication was left at the discretion of the physician. A:There is no medicine to reduce blood creatinine level. Our data suggest that an initial serum creatinine increase after better blood pressure control may not always be indicative that reduction of blood pressure lowering medication is necessary. The authors did not receive any funding for conducting this post hoc analysis. But I can’t emphasize this enough—it’s important to never abruptly stop a high blood pressure medication. An additional term for baseline renal function and baseline SBP was added to the model. An overview of the baseline characteristics stratified according to treatment group and creatinine increase is given in Table 1. URL: http://www.clinicaltrials.gov. She currently works in a hospital pharmacy and maintains a hospital-wide web page for over 75 hospital administrative assistants. The controlled blood pressure can help protect the residual kidney function and reduce creatinine and blood urea levels. Effects of intensive blood pressure treatment on acute kidney injury events in the systolic blood pressure intervention trial (SPRINT). Many cough and cold medications contain NSAIDs to relieve pain. Effects of intensive blood-pressure control in type 2 diabetes mellitus. However, in both treatment groups, patients with a >30% serum creatinine increase had a significantly higher risk for adverse outcomes compared with the other strata when adjusted for potential confounders. Lowering blood pressure may affect renal function. In patients with a <10% increase in serum creatinine, SBP decreased by 12.7 mm Hg in the intensive and 4.1 mm Hg in the standard treatment group, whereas in those with a >30% increase in creatinine SBP decreased by 25.4 and 16.3 mm Hg, respectively. Bitter Gourd. These data suggest that a >30% serum creatinine increase that coincides with lower blood pressure values should not directly lead to a reduction in antihypertensive medication in patients with type 2 diabetes mellitus. This suggests that a serum creatinine rise after initiation of antihypertensive therapy is a marker to identify high-risk patients, but that intensive therapy itself does not lead to a further increase in the risk for adverse outcomes. 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