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Clinical Nephrology
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Impact of Blood Pressure Control and Angiotensin-Converting Enzyme Inhibitor Therapy on New-Onset Microalbuminuria in Type 2 Diabetes: A Post Hoc Analysis of the BENEDICT Trial

Piero Ruggenenti, Annalisa Perna, Maria Ganeva, Bogdan Ene-Iordache, Giuseppe Remuzzi and ; for the BENEDICT Study Group
JASN December 2006, 17 (12) 3472-3481; DOI: https://doi.org/10.1681/ASN.2006060560
Piero Ruggenenti
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Annalisa Perna
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Maria Ganeva
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Bogdan Ene-Iordache
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Giuseppe Remuzzi
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  • Figure 1.
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    Figure 1.

    Patients who developed microalbuminuria throughout the study period according to follow-up systolic BP (SBP; A) or diastolic BP (DBP; B) above or below the median.

  • Figure 2.
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    Figure 2.

    Patients who had follow-up SBP (A) or DBP (B) above the median and developed microalbuminuria throughout the study period according to concomitant angiotensin-converting enzyme inhibitor (ACEi) therapy (yes or no).

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    Figure 3.

    Patients who developed microalbuminuria throughout the study period according to follow-up SBP (A) or DBP (B) reduction above or below the median.

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    Figure 4.

    Patients who had follow-up SBP (A) or DBP (B) reduction below the median and developed microalbuminuria throughout the study period according to concomitant ACEi therapy (yes or no).

Tables

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    Table 1.

    Patients who developed microalbuminuria according to baseline BP, follow-up BP, and BP reduction above or below the median and according to ACEi and ndCCB treatmenta

    ParameterSBPDBPMAPPulse Pressure
    BelowAboveBelowAboveBelowAboveBelowAbove
    Median baseline BP (mmHg)150.0088.33108.3361.67
        median4457485352495150
        ACEi no2838293731353531
        ACEi yes16g19f1916f21g14f16f19g
        CCB no2424242427212721
        CCB yes2033242925282429
    Median follow-up BP (mmHg)139.1681.33100.5757.60
        median3863b4160c3764b4160c
        ACEi no2046b2343d2046c2541d
        ACEi yes1817f1817f1718f1619f
        CCB no2226222622261830c
        CCB yes1637b1934c1538b2330
    Median BP reduction (mmHg)10.786.097.714.58
        median5843c5744c6041b5942d
        ACEi no4323c38284323c4224d
        ACEi yes15e2019g16df17f1817e18e
        CCB no272124242820d2919d
        CCB yes3122d3320c3221c3023
    • ↵a ACEi, angiotensin-converting enzyme inhibitor; DBP, diastolic BP; MAP, mean arterial pressure; ndCCB, nondihydropyridine calcium channel blocker; SBP, systolic BP.

    • ↵b P ≤ 0.001,

    • ↵c P ≤ 0.01,

    • ↵d P < 0.05 versus below;

    • ↵e P ≤ 0.001,

    • ↵f P ≤ 0.01,

    • ↵g P < 0.05 versus ACEi no.

    • View popup
    Table 2.

    Number (%) of patients in the trial who were on different antihypertensive treatments according to follow-up SBP, DBP, MAP, and pulse pressure above or below the median

    ParameterSBPDBPMAPPulse Pressure
    BelowAboveBelowAboveBelowAboveBelowAbove
    ACEi yes329 (55.6)263 (44.7)a325 (55.1)267 (45.3)a341 (57.7)251 (42.6)a308 (52.4)284 (48.0)
    ndCCB yes298 (50.3)292 (49.7)307 (52.0)283 (48.0)307 (52.0)283 (48.0)292 (49.7)298 (50.3)
    Veratran161 (27.2)132 (22.5)170 (28.8)123 (20.9)b174 (29.4)119 (20.2)a147 (25.0)146 (24.7)
    Trandolapril168 (28.4)131 (22.3)c155 (26.3)144 (24.4)167 (28.3)132 (22.4)c161 (27.4)138 (23.3)
    Verapamil137 (23.1)160 (27.2)137 (23.2)160 (27.1)133 (22.5)164 (27.8)c145 (24.7)152 (25.7)
    Placebo126 (21.3)165 (28.1)b128 (21.7)163 (27.6)c117 (19.8)174 (29.5)a135 (23.0)156 (26.4)
    Diuretic87 (14.7)142 (24.2)a100 (17.0)129 (21.9)c84 (14.2)145 (24.6)a99 (16.8)130 (22.0)c
    β blocker42 (7.1)61 (10.4)c44 ( 7.5)59 (10.0)45 (7.6)58 (9.9)43 ( 7.3)60 (10.1)
    dCCB84 (14.2)243 (41.3)a121 (20.5)206 (34.9)a79 (13.4)248 (42.1)a112 (19.1)215 (36.3)a
    Sympatholytic agent179 (30.2)378 (64.3)a202 (34.2)355 (60.2)a174 (29.4)383 (65.0)a211 (35.9)346 (58.5)a
    • ↵a P ≤ 0.001,

    • ↵b P ≤ 0.01,

    • ↵c P < 0.05 versus below.

    • View popup
    Table 3.

    SBP, DBP, MAP, and pulse pressure in patients who developed microalbuminuria as compared with those who did not develop microalbuminuria

    ParameterSBPDBPMAPPulse Pressure
    Baseline BP (mmHg)
        microalbuminuria yes151.2 ± 13.387.9 ± 8.5109.0 ± 8.863.3 ± 11.3
        microalbuminuria no150.8 ± 14.387.4 ± 7.6108.6 ± 8.363.4 ± 12.9
    Follow-up BP (mmHg)
        microalbuminuria yes143.3 ± 9.982.7 ± 6.0102.9 ± 6.360.6 ± 8.7
        microalbuminuria no140.2 ± 11.3a81.5 ± 5.7b101.1 ± 6.5a58.7 ± 10.1
    BP reduction (mmHg)
        microalbuminuria yes7.9 ± 11.55.2 ± 6.46.1 ± 7.42.7 ± 8.6
        microalbuminuria no10.6 ± 11.9b6.0 ± 6.87.5 ± 7.74.6 ± 9.3
    • ↵a P ≤ 0.01,

    • ↵b P < 0.05 versus microalbuminuria yes.

    • View popup
    Table 4.

    Baseline characteristics of patients according to SBP reduction above or below the mediana

    CharacteristicsAbove(n = 592)Below(n = 592)P
    Demographic characteristics
        age (yr)61.9 ± 8.062.6 ± 8.00.1006
        male341 (57.6)287 (48.5)0.0017
    Clinical characteristics
        BMI (kg/m2)28.9 ± 4.629.4 ± 4.80.0562
        known duration of diabetes (yr)7.9 ± 6.57.7 ± 6.70.6311
        smokers0.0799
            never324 (54.7)361 (61.0)
            former194 (32.8)162 (27.3)
            current74 (12.5)69 (11.7)
    Laboratory variables
        glycosylated hemoglobin (%)5.8 ± 1.45.8 ± 1.40.9070
        glucose (mg/dl)162.7 ± 45.4159.5 ± 48.80.2422
        BP (mmHg)
            SBP157.4 ± 12.2144.4 ± 13.0<0.0001
            DBP89.9 ± 7.185.2 ± 7.5<0.0001
            MAP112.4 ± 7.2104.9 ± 7.8<0.0001
        urinary albumin excretion (μg/min)7.1 ± 4.66.8 ± 4.60.3135
        serum creatinine (mg/dl)0.9 ± 0.20.9 ± 0.20.2295
    GFR (ml/min per 1.73 m2)106.9 ± 16.8115.1 ± 20.20.1054
        triglycerides (mg/dl)147.0 ± 86.9146.0 ± 78.90.8372
        total cholesterol (mg/dl)209.7 ± 37.5210.4 ± 35.50.7620
    • ↵a Data are mean ± SD or n (%). BMI, body mass index.

    • View popup
    Table 5.

    Number (%) of patients in the trial who were on different antihypertensive treatments according to SBP, DBP, MAP, and pulse pressure reduction above or below the median

    ParameterSBPDBPMAPPulse Pressure
    AboveBelowAboveBelowAboveBelowAboveBelow
    ACEi yes319 (53.9)273 (46.4)c323 (54.6)269 (45.8)b316 (53.3)276 (47.0)c317 (53.6)275 (46.8)c
    ndCCB yes293 (49.5)297 (50.5)300 (50.7)290 (49.3)303 (51.1)287 (48.9)283 (47.8)307 (52.2)
    Veratran158 (26.7)135 (23.0)157 (26.5)136 (23.1)160 (27.0)133 (22.7)153 (25.8)140 (23.8)
    Trandolapril161 (27.2)138 (23.5)166 (28.0)133 (22.6)c156 (26.3)143 (24.4)164 (27.7)135 (23.0)
    Verapamil135 (22.8)162 (27.6)143 (24.2)154 (26.2)143 (24.1)154 (26.2)130 (22.0)167 (28.4)c
    Placebo138 (23.3)152 (26.0)126 (21.3)165 (28.1)b134 (22.6)157 (26.8)145 (24.5)146 (24.8)
    Diuretic97 (16.4)132 (22.5)c95 (16.1)134 (22.8)b98 (16.5)131 (22.3)c105 (17.7)124 (21.1)
    β-Blocker44 (7.4)59 (10.0)47 (7.9)56 (9.5)45 (7.6)58 (9.9)51 (8.6)52 (8.8)
    dCCB142 (24.0)185 (31.5)b145 (24.5)182 (31.0)c137 (23.1)190 (32.4)a160 (27.0)167 (28.4)
    Sympatholytic agent265 (44.8)292 (49.7)250 (42.2)307 (52.2)a256 (43.2)301 (51.3)b276 (46.6)281 (47.8)
    • ↵a P ≤ 0.001,

    • ↵b P ≤ 0.01,

    • ↵c P < 0.05 versus below.

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Journal of the American Society of Nephrology: 17 (12)
Journal of the American Society of Nephrology
Vol. 17, Issue 12
December 2006
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Impact of Blood Pressure Control and Angiotensin-Converting Enzyme Inhibitor Therapy on New-Onset Microalbuminuria in Type 2 Diabetes: A Post Hoc Analysis of the BENEDICT Trial
Piero Ruggenenti, Annalisa Perna, Maria Ganeva, Bogdan Ene-Iordache, Giuseppe Remuzzi
JASN Dec 2006, 17 (12) 3472-3481; DOI: 10.1681/ASN.2006060560

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Impact of Blood Pressure Control and Angiotensin-Converting Enzyme Inhibitor Therapy on New-Onset Microalbuminuria in Type 2 Diabetes: A Post Hoc Analysis of the BENEDICT Trial
Piero Ruggenenti, Annalisa Perna, Maria Ganeva, Bogdan Ene-Iordache, Giuseppe Remuzzi
JASN Dec 2006, 17 (12) 3472-3481; DOI: 10.1681/ASN.2006060560
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