Effect of Intensive Blood Pressure Control With Valsartan on Urinary Albumin Excretion in Normotensive Patients With Type 2 Diabetes

Background Diabetes is the most common cause of renal failure in the United States, and data regarding the effects of aggressive blood pressure (BP) therapy in normotensive patients with type 2 diabetes are inadequate. Methods A total of 129 type 2 diabetic patients with a BP of <140/80 to 90 mm Hg without overt albuminuria were randomized to either intensive BP control (diastolic BP goal 75 mm Hg) using an angiotensin II receptor blocker, valsartan, versus moderate BP control (diastolic BP 80 to 90 mm Hg with placebo initially) to evaluate the effect on the change in urinary albumin excretion (UAE) from baseline. Results The mean entrance BP was 126 ± 8.8/84 ± 2.4 mm Hg. The mean follow-up period was 1.9 ± 1.0 years. During the follow-up period, the mean BP was 118 ± 10.9/75 ± 5.7 for the intensive v 124 10.9/80 6.5 mm Hg for the moderate BP groups (P< .001). No difference was observed in change in creatinine clearance or serum creatinine from baseline between the two groups. An analysis of covariance model for change in log (UAE + 1), adjusting for age, HBA1c, duration of diabetes, baseline log (UAE + 1), sex, and ethnicity resulted in a significant treatment difference at 2 years (P = .007) with intensive BP control reducing log (UAE+1) compared with moderate BP control. Conclusion Intensive BP control with valsartan to <120/80 mm Hg in normotensive patients with type 2 diabetes and normo- or microalbuminuria significantly decreased the progression of UAE and in some cases caused regression of UAE.