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Background:Diabetes and hypertension are risk factors for renal and cardiovascular outcomes. Data on the association of achieved blood pressure (BP) with renal outcomes in patients with and without diabetes are sparse. We investigated the association of achieved SBP, DBP with renal outcomes and urinary albumin excretion (UAE) in people with vascular disease.Methods:In this pooled analysis, we assessed renal outcome data from high-risk patients aged 55 years or older with a history of cardiovascular disease, 70% of whom had hypertension, randomized to The Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial and to Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease trials investigating telmisartan, ramipril and their combination with a median follow-up of 56 months. Standardized office BP was measured every 6 months, estimated glomerular filtration rate (eGFR) and UAE at baseline, 2 years and study end. Associations of mean achieved BP on treatment were investigated on major renal outcomes including end-stage renal disease (ESRD), decline of eGFR by at least 40%, doubling of creatinine and the composites thereof and on UAE. Analyses were by Cox regression analysis, analysis of variance and Chi2-Test. Of 30 937 patients with complete data, 19 450 patients without and 11 487 with diabetes were enrolled between 1 December 2001 and 31 July 2003 and followed until 31 July 2008. Data were pooled as the outcomes for telmisartan 80 mg/day (n = 2903) or placebo (n = 2907) for Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease and ramipril 10 mg/day (n = 8407), telmisartan 80 mg/day (n = 8386) or the combination of both (n = 8334) were similar.Results:For both those with and without diabetes, the hazard ratios for the composites ESRD or doubling of serum creatinine (707 events overall) and ESRD or 40% eGFR loss (2371 events overall) reached a nadir at achieved SBP

Herz und Nieren sind in ihrer physiologischen Interaktion eng miteinander verbunden. Kardiovaskuläre Erkrankungen sind die häufigste Todesursache bei Patienten mit chronischer Nierenerkrankung, wobei diese wiederum das Auftreten und das Fortschreiten kardiovaskulärer Erkrankungen begünstigen kann. Die Therapie der koronaren Herzkrankheit (KHK) und der chronischen Herzinsuffizienz unterscheidet sich bei Patienten mit einer milden Nierenfunktionseinschränkung (geschätzte glomeruläre Filtrationsrate [eGFR]: >60 ml/min/1,73 m2) nicht wesentlich von der Therapie nierengesunder Patienten. Da Patienten mit einer fortgeschrittenen Niereninsuffizienz aus den Zulassungsstudien meist ausgeschlossen wurden, basieren viele Therapieempfehlungen in dieser Patientengruppe auf Beobachtungsstudien, Subgruppen- und Metaanalysen oder pathophysiologischen Erwägungen, die nicht durch kontrollierte Studien gestützt sind. Daher werden prospektive, randomisierte Studien zur Therapie von KHK und Herzinsuffizienz benötigt, die Patienten mit fortgeschrittener Nierenfunktionseinschränkung gezielt untersuchen. There is a close physiological relationship between the kidneys and the heart. Cardiovascular diseases are the most prevalent cause of death in patients with chronic kidney disease (CKD), whereas CKD may directly accelerate the progression of cardiovascular diseases and is considered to be a cardiovascular risk factor. In patients with mild CKD, i.e. an estimated glomerular filtration rate (eGFR) >60 ml/min/1.73 m2, treatment of coronary artery disease and chronic heart failure is not essentially different from patients with preserved renal function; however, as most pivotal trials have systematically excluded patients with advanced renal failure, many treatment recommendations in this patient group are based on observational studies, post hoc subgroup analyses and meta-analyses or pathophysiological considerations, which are not supported by controlled studies. Therefore, prospective rand