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

doi:10.1681/ASN.2006060560

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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.
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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).

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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 treatment^a

Parameter	SBP		DBP		MAP		Pulse Pressure
Parameter	Below	Above	Below	Above	Below	Above	Below	Above
Median baseline BP (mmHg)	150.00		88.33		108.33		61.67
median	44	57	48	53	52	49	51	50
ACEi no	28	38	29	37	31	35	35	31
ACEi yes	16^g	19^f	19	16^f	21^g	14^f	16^f	19^g
CCB no	24	24	24	24	27	21	27	21
CCB yes	20	33	24	29	25	28	24	29
Median follow-up BP (mmHg)	139.16		81.33		100.57		57.60
median	38	63^b	41	60^c	37	64^b	41	60^c
ACEi no	20	46^b	23	43^d	20	46^c	25	41^d
ACEi yes	18	17^f	18	17^f	17	18^f	16	19^f
CCB no	22	26	22	26	22	26	18	30^c
CCB yes	16	37^b	19	34^c	15	38^b	23	30
Median BP reduction (mmHg)	10.78		6.09		7.71		4.58
median	58	43^c	57	44^c	60	41^b	59	42^d
ACEi no	43	23^c	38	28	43	23^c	42	24^d
ACEi yes	15^e	20	19^g	16^d ^f	17^f	18	17^e	18^e
CCB no	27	21	24	24	28	20^d	29	19^d
CCB yes	31	22^d	33	20^c	32	21^c	30	23

↵^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.

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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

Parameter	SBP		DBP		MAP		Pulse Pressure
Parameter	Below	Above	Below	Above	Below	Above	Below	Above
ACEi yes	329 (55.6)	263 (44.7)^a	325 (55.1)	267 (45.3)^a	341 (57.7)	251 (42.6)^a	308 (52.4)	284 (48.0)
ndCCB yes	298 (50.3)	292 (49.7)	307 (52.0)	283 (48.0)	307 (52.0)	283 (48.0)	292 (49.7)	298 (50.3)
Veratran	161 (27.2)	132 (22.5)	170 (28.8)	123 (20.9)^b	174 (29.4)	119 (20.2)^a	147 (25.0)	146 (24.7)
Trandolapril	168 (28.4)	131 (22.3)^c	155 (26.3)	144 (24.4)	167 (28.3)	132 (22.4)^c	161 (27.4)	138 (23.3)
Verapamil	137 (23.1)	160 (27.2)	137 (23.2)	160 (27.1)	133 (22.5)	164 (27.8)^c	145 (24.7)	152 (25.7)
Placebo	126 (21.3)	165 (28.1)^b	128 (21.7)	163 (27.6)^c	117 (19.8)	174 (29.5)^a	135 (23.0)	156 (26.4)
Diuretic	87 (14.7)	142 (24.2)^a	100 (17.0)	129 (21.9)^c	84 (14.2)	145 (24.6)^a	99 (16.8)	130 (22.0)^c
β blocker	42 (7.1)	61 (10.4)^c	44 ( 7.5)	59 (10.0)	45 (7.6)	58 (9.9)	43 ( 7.3)	60 (10.1)
dCCB	84 (14.2)	243 (41.3)^a	121 (20.5)	206 (34.9)^a	79 (13.4)	248 (42.1)^a	112 (19.1)	215 (36.3)^a
Sympatholytic agent	179 (30.2)	378 (64.3)^a	202 (34.2)	355 (60.2)^a	174 (29.4)	383 (65.0)^a	211 (35.9)	346 (58.5)^a

↵^a P ≤ 0.001,
↵^b P ≤ 0.01,
↵^c P < 0.05 versus below.

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Table 3.

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

Parameter	SBP	DBP	MAP	Pulse Pressure
Baseline BP (mmHg)
microalbuminuria yes	151.2 ± 13.3	87.9 ± 8.5	109.0 ± 8.8	63.3 ± 11.3
microalbuminuria no	150.8 ± 14.3	87.4 ± 7.6	108.6 ± 8.3	63.4 ± 12.9
Follow-up BP (mmHg)
microalbuminuria yes	143.3 ± 9.9	82.7 ± 6.0	102.9 ± 6.3	60.6 ± 8.7
microalbuminuria no	140.2 ± 11.3^a	81.5 ± 5.7^b	101.1 ± 6.5^a	58.7 ± 10.1
BP reduction (mmHg)
microalbuminuria yes	7.9 ± 11.5	5.2 ± 6.4	6.1 ± 7.4	2.7 ± 8.6
microalbuminuria no	10.6 ± 11.9^b	6.0 ± 6.8	7.5 ± 7.7	4.6 ± 9.3

↵^a P ≤ 0.01,
↵^b P < 0.05 versus microalbuminuria yes.

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Table 4.

Baseline characteristics of patients according to SBP reduction above or below the median^a

Characteristics	Above(n = 592)	Below(n = 592)	P
Demographic characteristics
age (yr)	61.9 ± 8.0	62.6 ± 8.0	0.1006
male	341 (57.6)	287 (48.5)	0.0017
Clinical characteristics
BMI (kg/m²)	28.9 ± 4.6	29.4 ± 4.8	0.0562
known duration of diabetes (yr)	7.9 ± 6.5	7.7 ± 6.7	0.6311
smokers			0.0799
never	324 (54.7)	361 (61.0)
former	194 (32.8)	162 (27.3)
current	74 (12.5)	69 (11.7)
Laboratory variables
glycosylated hemoglobin (%)	5.8 ± 1.4	5.8 ± 1.4	0.9070
glucose (mg/dl)	162.7 ± 45.4	159.5 ± 48.8	0.2422
BP (mmHg)
SBP	157.4 ± 12.2	144.4 ± 13.0	<0.0001
DBP	89.9 ± 7.1	85.2 ± 7.5	<0.0001
MAP	112.4 ± 7.2	104.9 ± 7.8	<0.0001
urinary albumin excretion (μg/min)	7.1 ± 4.6	6.8 ± 4.6	0.3135
serum creatinine (mg/dl)	0.9 ± 0.2	0.9 ± 0.2	0.2295
GFR (ml/min per 1.73 m²)	106.9 ± 16.8	115.1 ± 20.2	0.1054
triglycerides (mg/dl)	147.0 ± 86.9	146.0 ± 78.9	0.8372
total cholesterol (mg/dl)	209.7 ± 37.5	210.4 ± 35.5	0.7620

↵^a Data are mean ± SD or n (%). BMI, body mass index.

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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

Parameter	SBP		DBP		MAP		Pulse Pressure
Parameter	Above	Below	Above	Below	Above	Below	Above	Below
ACEi yes	319 (53.9)	273 (46.4)^c	323 (54.6)	269 (45.8)^b	316 (53.3)	276 (47.0)^c	317 (53.6)	275 (46.8)^c
ndCCB yes	293 (49.5)	297 (50.5)	300 (50.7)	290 (49.3)	303 (51.1)	287 (48.9)	283 (47.8)	307 (52.2)
Veratran	158 (26.7)	135 (23.0)	157 (26.5)	136 (23.1)	160 (27.0)	133 (22.7)	153 (25.8)	140 (23.8)
Trandolapril	161 (27.2)	138 (23.5)	166 (28.0)	133 (22.6)^c	156 (26.3)	143 (24.4)	164 (27.7)	135 (23.0)
Verapamil	135 (22.8)	162 (27.6)	143 (24.2)	154 (26.2)	143 (24.1)	154 (26.2)	130 (22.0)	167 (28.4)^c
Placebo	138 (23.3)	152 (26.0)	126 (21.3)	165 (28.1)^b	134 (22.6)	157 (26.8)	145 (24.5)	146 (24.8)
Diuretic	97 (16.4)	132 (22.5)^c	95 (16.1)	134 (22.8)^b	98 (16.5)	131 (22.3)^c	105 (17.7)	124 (21.1)
β-Blocker	44 (7.4)	59 (10.0)	47 (7.9)	56 (9.5)	45 (7.6)	58 (9.9)	51 (8.6)	52 (8.8)
dCCB	142 (24.0)	185 (31.5)^b	145 (24.5)	182 (31.0)^c	137 (23.1)	190 (32.4)^a	160 (27.0)	167 (28.4)
Sympatholytic agent	265 (44.8)	292 (49.7)	250 (42.2)	307 (52.2)^a	256 (43.2)	301 (51.3)^b	276 (46.6)	281 (47.8)

↵^a P ≤ 0.001,
↵^b P ≤ 0.01,
↵^c P < 0.05 versus below.

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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

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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

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