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(Hypertension. 2007;49:48.)
© 2007 American Heart Association, Inc.

Original Articles

Relationship Between Low-Normal Blood Pressure and Kidney Disease in Type 1 Diabetes

Anoop Shankar; Ronald Klein; Barbara E.K. Klein; F. Javier Nieto; Scot E. Moss

From the Department of Community, Occupational, and Family Medicine (A.S.), National University of Singapore, Singapore; and the Departments of Ophthalmology and Visual Sciences (R.K., B.E.K.K., S.E.M.) and Population Health Sciences (F.J.N.), University of Wisconsin, School of Medicine and Public Health, Madison.

Correspondence to Anoop Shankar, Department of Community, Occupational, and Family Medicine, National University of Singapore, 16 Medical Dr, Singapore 117597. E-mail ashankar{at}nus.edu.sg

Current recommendations, largely based on studies in type 2 diabetes, suggest lower target blood pressures (BPs) for individuals with diabetes than for the general population. However, the effect of lower BP on renal outcomes in type 1 diabetes is uncertain. In a population-based cohort of type 1 diabetes adults (mean age: 33.1 years) based in Wisconsin, of which the distribution of baseline BP was in the low-normal range, we examined the relationship between decreasing categories of systolic and diastolic BP and the 16-year incidence of proteinuria (n=232 of 604) and estimated glomerular filtration rate of <60 mL/min/1.73 m² (n=158 of 547). Decreasing BP categories had lower relative risk (RR) of developing incident proteinuria (RR comparing decreasing quartiles of systolic BP: 1.00, 0.76, 0.58, 0.73; P for trend=0.03; RR comparing decreasing quartiles of diastolic BP: 1.00, 0.81, 0.66, 0.42; P for trend <0.0001) and incident estimated glomerular filtration rate <60 mL/min/1.73 m² (RR comparing decreasing quartiles of systolic BP: 1.00, 0.83, 0.61, 0.65; P for trend=0.03; RR comparing decreasing quartiles of diastolic BP: 1.00, 0.84, 0.82, 0.43; P for trend=0.001). These associations were independent of glycemic control and several putative confounding factors. Subjects with either systolic BP <120 mm Hg or diastolic BP <70 mm Hg had significantly lower RR (95% confidence interval) of incident proteinuria (0.63 [0.48 to 0.82]) and incident estimated glomerular filtration rate <60 mL/min/1.73 m² (0.60 [0.43 to 0.82]); corresponding population-attributable risks for these outcomes were 26.7% and 29.5%, respectively. Our study suggests that lower BP levels, even below the accepted normal range, are protective against kidney disease in adults with type 1 diabetes. Interventional trials are desirable to clarify the clinical significance of this association.

Key Words: type 1 diabetes • blood pressure • chronic kidney disease • GFR • proteinuria • WESDR

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