{"id":"c435778e6450","type":"article","url":"https://hartvaat.nl/2018/12/01/creatininestijging-tijdens-bloeddrukbehandeling-en-uitkomsten-bij-diabetes-type-/","title":"Creatininestijging tijdens bloeddrukbehandeling en uitkomsten bij diabetes type 2","title_en":"Creatinine Rise During Blood Pressure Therapy and the Risk of Adverse Clinical Outcomes in Patients With Type 2 Diabetes Mellitus.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["anemie-ckd","bloeddrukbehandeling","chronische-nierziekte","credence-trial","diabetes-en-hart","diabetes-type-1","diabetes-type-2","fidelio-dkd","figaro-dkd","soul-trial"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.118.11944","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.118.11944","authors":["Didier Collard","Tom F Brouwer","Ron J G Peters","Liffert Vogt","Bert-Jan H van den Born"],"significance":5,"published":"2018-12-01","source_date":"2018-12-01","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"This study showed that creatinine rise during antihypertensive therapy in type 2 diabetes does not consistently predict adverse outcomes, suggesting that moderate renal function changes should not always prompt treatment de-escalation.","created":"2026-07-03T10:27:38Z","updated":"2026-07-03T13:26:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het risico op ongunstige uitkomsten bij creatininestijging tijdens antihypertensieve behandeling bij diabetes type 2.","abstract_original":"Lowering blood pressure may affect renal function. Current guidelines state that reducing antihypertensive therapy should be considered in patients with a >30% serum creatinine increase after initiation of antihypertensive therapy. We examined the association between a serum creatinine increase and adverse clinical outcomes in the ACCORD-BP trial (Action to Control Cardiovascular Risk in Diabetes Blood Pressure), were patients with type 2 diabetes mellitus were randomized to intensive (target systolic blood pressure <120 mm Hg) and standard antihypertensive (<140 mm Hg) treatment. The primary outcome was a combined end point consisting of all-cause mortality, major cardiovascular events, and renal failure. Patients were stratified into 3 groups according to serum creatinine increase between baseline and 4 months (<10%, 10%-30%, >30%). A total of 4733 patients, aged 62.2 years, 52% men with a mean estimated glomerular filtration rate 81.5 mL/min per 1.73 m2 were included. Follow-up was available for 4446 patients, 2231 were randomized to intensive and 2215 to standard therapy. Kaplan-Meier analysis showed no association between a serum creatinine increase and the composite end point in the intensive ( P=0.20) and the standard treatment group ( P=0.17). After adjusting for possible confounders, a >30% serum creatinine increase was associated with a higher risk of clinical adverse outcomes in both treatment groups, but to a similar extent. These data suggest that a >30% serum creatinine increase that coincides with lower blood pressure values should not directly lead to a reduction in antihypertensive medication in patients with type 2 diabetes mellitus. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT00000620."}