Dr Vivek Baliga – ONTARGET and TRANSCEND studies Synopsis

Synopsis by Dr Vivek Baliga

Mortality and morbidity in relation to changes in albuminuria, glucose status and systolic blood pressure: an analysis of the ONTARGET and TRANSCEND studies

Diabetologia 2014;57:2019–2029 

Preamble

 Urinary albumin excretion is a strong predictor of cardiovascular disease

  • It is uncertain whether improvement from microalbuminuria or deterioration from normoalbuminuria over time in patients with differing changes in glucose and BP change their cardiovascular risk 

Salient Features of the study 

  • Data on mortality, cardiovascular and renal outcomes were analysed in 22,984 patients from two large parallel randomised clinical trials – ONTARGET and TRANSCEND followed for 56 months
  • A central laboratory analysed first morning spot urine samples at baseline and after 24 months, and events were recorded over the subsequent 32 months
  • Patients were stratified by changes in albuminuria, glucose status and mean systolic BP over 2 years
  • There was a strong association between albuminuria status and all-cause and cardiovascular mortality and combined cardiovascular and renal endpoints (all p<0.0001)
  • Changes in systolic BP control had no effect on mortality, whereas glucose status was significantly associated with all outcomes
  • Irrespective of BP control or glucose status, patients showing an improvement from microalbuminuria to normoalbuminuria after 2 years were at a lower risk of all outcome measures than patients showing deterioration from normoalbuminuria to microalbuminuria (HR for all-cause mortality 0.65 [0.52–0.83], p=0.0004)

 Conclusions 

The authors concluded the following

  • Patients who showed improvement to normoalbuminuria over 2 years were at lower risk of all-cause and cardiovascular mortality and of cardiovascular and renal events than those who deteriorated to microalbuminuria over time
  • Albuminuria over time was significantly better than glucose status and BP control in predicting mortality and both cardiovascular and renal outcomes in patients at a high cardiovascular risk

The article can be accessed at the below mentioned link.

http://link.springer.com/article/10.1007%2Fs00125-014-3330-9

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