Blood pressure lowering beneficial to all diabetics, even those with normal levels, Australian researchers have found.
A study by the George Institute for International Health found that a combination of two blood pressure lowering treatments had significantly reduced the risk of kidney disease among patients with type 2 diabetes.
An estimated 250 million people are living with diabetes around the world. Kidney disease is a common (more than half of type 2 diabetes patients develop renal impairment) and devastating complication of diabetes - up to 20 per cent of people with diabetes die of renal failure.
"Our research demonstrated that lowering blood pressure with an ACE inhibitor/diuretic combination reduces the risk of kidney complications by 20 per cent, and even resolves some early manifestations of kidney disease in people with diabetes, regardless of whether their blood pressure is normal or elevated," said co-author, Dr Vlado Perkovic, The George Institute for International Health.
The key findings of the paper, published in the Journal of the American Society of Nephrology
, shows that this treatment has wide benefits for all patients with type 2 diabetes. "For all people with diabetes, reducing their risk of kidney disease is imperative. Individuals who develop kidney disease are at significantly increased risk of developing cardiovascular complications, which is the major cause of death in these patients," added Dr Perkovic.
The ADVANCE (Action in Diabetes and Vascular Disease) study was initiated and designed by Australia's George Institute for International Health and involved a group of independent medical researchers from 20 countries worldwide. This new analysis aimed to examine the effects of blood pressure lowering on kidney disease in people with diabetes and a broad range of blood pressure levels.
ADVANCE involved 11,140 patients with type 2 diabetes who were treated and followed up for five years. One group received a combination of two antihypertensive (blood pressure-lowering) drugs: the angiotensin-converting enzyme (ACE) inhibitor perindopril and the diuretic drug indapamide. The other group received inactive placebos.
Worldwide, more than a million people receive dialysis on an ongoing basis, and up to 20% of these patients will die each year. These patients have an extremely high risk of death - in the USA 1 in 8 dialysis patients will die each year. Until now, no one has proven how to reduce this high risk.
For the first time, Australian researchers at The George Institute have identified that blood pressure lowering treatment significantly reduces the risk of death for dialysis patients. As a world-first, this systematic review has been fast tracked by the Lancet and will be published online.
The report concluded that "Treatment with agents that lower blood pressure should routinely be considered for individuals undergoing dialysis to reduce the very high cardiovascular morbidity and mortality rate in this population."