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Abstract: FR-PO1021

Heart Failure Risk with Intensive Systolic Blood Pressure (SBP) Lowering Does Not Differ by Albuminuria Status in Diabetes

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Chaturvedula, Chandra Kanth, Loyola University Medical Center, Maywood, Illinois, United States
  • Kramer, Holly J., Loyola University Medical Center, Maywood, Illinois, United States
  • Wei, Guo, University of Utah, Salt Lake City, Utah, United States
  • Boucher, Robert E., University of Utah School of Medicine, Sandy, Utah, United States
  • Kalipatnapu, Sri Mahathi Priyanka, Macneal Hospital, Berwyn, Illinois, United States
  • Beddhu, Srinivasan, University of Utah School of Medicine, Sandy, Utah, United States
Background

Albuminuria is associated with heightened risk for heart failure (HF) in persons with diabetes mellitus (DM) but optimal SBP goals for reducing HF risk remain controversial. We examined the effects of intensive vs. standard SBP lowering on HF risk by baseline albuminuria status among adults with DM.

Methods

Using data from the Action to Control Cardiovascular Disease (ACCORD) trial. Kaplan Meier curves were used to examine time to acute decompensated HF events by intensive vs. standard SBP lowering and by baseline albuminuria status (albumin-to-creatinine ratio < 30 mg/g vs. ≥ 30 mg/g) after stratifying by intensive vs. standard glucose control. Interaction terms of albuminuria x intensive SBP lowering on HF risk were fitted into Cox proportional hazard models while adjusting for demographics, estimated glomerular filtration rate, blood pressure, and heart disease.

Results

A total of 4524 patients (2257 in standard SBP arm, mean age 62.5 (6.5) years and baseline SBP (142.9 (15.8) mmHg and 2267 in intensive SBP arm, mean age 63.2 years and baseline SBP 137.1 (14.6) mmHg), were followed for a mean of 4.78 years. Within the standard glycemia arm, the absolute risk difference of HF (intensive vs. standard SBP) was -0.35(-1.32, 0.62) in ACR<30 and -1.5(-4.19,1.18) in ACR >30, whereas in the intensive glycemia arm, it was 0.77( -0.48,1.18) in ACR<30 and 1.05(-1.89,3.98) in ACR >30. Hazard Ratio(95% CI) in the standard arm was 0.73(0.34,1.58) and 0.73(0.41,1.31) in the ACR <30 and ACR>30 respectively, and in the intensive arm 1.24(0.65, 2.37) and 1.16(0.66, 2.04) in the ACR <30 and >30 respectively.

Conclusion

The effects of intensive SBP lowering on HF rates does not appear to be modified by albuminuria status in adults with DM.

Absolute risk difference and Hazard ratio in both the groups