ArticleThe lancet. Diabetes & endocrinology2018
Intensive systolic blood pressure control and incident chronic kidney disease in people with and without diabetes mellitus: secondary analyses of two randomised controlled trials.
Article in The lancet. Diabetes & endocrinology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 60 papers, 8 of them syntheses that pooled it.
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Who cites it
60 citing papers in PubMed, 8 syntheses or guidelines pooled it, 119 citations in OpenAlex.
- [Individualizing antihypertensive therapy in diabetes mellitus. Guidelines of the Austrian Diabetes Association (Update 2026)].Wiener klinische Wochenschrift · 2026Guideline
- Systolic blood pressure targets below 120 mm Hg are associated with reduced mortality: A meta-analysis.Journal of internal medicine · 2025Pooled it
- Pharmacological Nephroprotection in Chronic Kidney Disease Patients with Type 2 Diabetes Mellitus-Clinical Practice Position Statement of the Polish Society of Nephrology.International journal of molecular sciences · 2024Guideline
- 2023 Clinical Practice Guidelines for Diabetes Management in Korea: Full Version Recommendation of the Korean Diabetes Association.Diabetes & metabolism journal · 2024Guideline
- [Individualising antihypertensive therapy in patients with diabetes. A guideline by the Austrian Diabetes Association (update 2023)].Wiener klinische Wochenschrift · 2023Guideline
- American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2022Guideline
- Pooled it
- The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019).Hypertension research : official journal of the Japanese Society of Hypertension · 2019Guideline
- Effects of Intensive Systolic Blood Pressure Control on Kidney Outcomes in Patients With and Without CKD: A Post Hoc Analysis of SPRINT and ACCORD-BP Trials.Journal of diabetes · 2025Trial
- Intensive Systolic Blood Pressure Reduction and Kidney and Cardiovascular Outcomes: A Secondary Analysis of a Randomized Clinical Trial.JAMA network open · 2025Trial
- Association of baseline eGFR and incident heart failure on patients receiving intensive blood pressure treatment.ESC heart failure · 2025Trial
- Trial
- Implications of Early Decline in eGFR due to Intensive BP Control for Cardiovascular Outcomes in SPRINT.Journal of the American Society of Nephrology : JASN · 2019Trial
- Article
- Integrating Blood Pressure Control With Multi-Class Kidney Protective Agents in Diabetic Kidney Disease.Electrolyte & blood pressure : E & BP · 2026Review
- Blood pressure and renal function decline in apparently healthy adults: the tehran lipid and glucose study.Journal of human hypertension · 2026Article
- 2024 Thai guidelines on the treatment of hypertension.Asian biomedicine : research, reviews and news · 2025Article
- Nonlinear association between glycemic markers and incident cardio‑renal‑metabolic multimorbidity: two decades of follow‑up in the Tehran Lipid and Glucose Study.American journal of preventive cardiology · 2025Article
- Association of the triglyceride-glucose index and its combination with obesity indices with cardio-renal-metabolic multimorbidity: two decades of follow-up in the Tehran Lipid and Glucose Study.Cardiovascular diabetology · 2025Article
- Review
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Authors and funding
13 authors at 8 institutions in 1 country.
Funding
Abstract
backgroundGuidelines, including the 2017 American College of Cardiology and American Heart Association blood pressure guideline, recommend tighter control of systolic blood pressure in people with type 2 diabetes. However, it is unclear whether intensive lowering of systolic blood pressure increases the incidence of chronic kidney disease in this population. We aimed to compare the effects of intensive systolic blood pressure control on incident chronic kidney disease in people with and without type 2 diabetes.
methodsThe Systolic Blood Pressure Intervention Trial (SPRINT) tested the effects of a systolic blood pressure goal of less than 120 mm Hg (intensive intervention) versus a goal of less than 140 mm Hg (standard intervention) in people without diabetes. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure trial tested a similar systolic blood pressure intervention in people with type 2 diabetes. Our study is a secondary analysis of limited access datasets from SPRINT and the ACCORD trial obtained from the National Institutes of Health. In participants without chronic kidney disease at baseline (n=4311 in the ACCORD trial; n=6715 in SPRINT), we related systolic blood pressure interventions (intensive vs standard) to incident chronic kidney disease (defined as >30% decrease in estimated glomerular filtration rate [eGFR] to <60 mL/min per 1·73 m
findingsThe average difference in systolic blood pressure between intensive and standard interventions was 13·9 mm Hg (95% CI 13·4-14·4) in the ACCORD trial and 15·2 mm Hg (14·8-15·6) in SPRINT. At 3 years, the cumulative incidence of chronic kidney disease in the ACCORD trial was 10·0% (95% CI 8·8-11·4) with the intensive intervention and 4·1% (3·3-5·1) with the standard intervention (absolute risk difference 5·9%, 95% CI 4·3-7·5). Corresponding values in SPRINT were 3·5% (95% CI 2·9-4·2) and 1·0% (0·7-1·4; absolute risk difference 2·5%, 95% CI 1·8-3·2). The absolute risk difference was significantly higher in the ACCORD trial than in SPRINT (p=0·0001 for interaction).
interpretationIntensive lowering of systolic blood pressure increased the risk of incident chronic kidney disease in people with and without type 2 diabetes. However, the absolute risk of incident chronic kidney disease was higher in people with type 2 diabetes. Our findings suggest the need for vigilance in monitoring kidney function during intensive antihypertensive drug treatment, particularly in adults with diabetes. Long-term studies are needed to understand the clinical implications of antihypertensive treatment-related reductions in eGFR.
fundingNational Institutes of Health.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.