A community-based model of care improves blood pressure control and delays progression of proteinuria, left ventricular hypertrophy and diastolic dysfunction in M(a)over-barori and Pacific patients with type 2 diabetes and chronic kidney disease: a randomized controlled trial

Methods. Sixty-five M (a) over bar ori and Pacific patients (aged 47-75 years) with type 2 diabetes, moderate CKD (> 0.5 g proteinuria/day, serum creatinine 130-300 mu mol/l) and hypertension were randomized to usual care (n = 32) or community/intervention care (n = 33) for 12 months. Community care patients were visited monthly by a nurse-led health-care assistant for BP measurement. Antihypertensives were adjusted using a stepwise protocol, aiming for a BP < 130/80 mmHg. Office BP and renal and echocardiographic parameters were measured at baseline and 12 months. Results. Baseline characteristics including office BP, renal and echocardiographic parameters, and number of antihypertensives were well matched in both groups. By 12 months, the community care patients had achieved a significantly greater reduction in office systolic BP (-21 +/- 26 mmHg vs -12 +/- 20 mmHg, P = 0.04) and in 24-h urine protein (-1.4 +/- 2.6 g vs +0.1 +/- 2.8 g, P = 0.04). The number of prescribed antihypertensives was greater in these patients at 12 months (3.4 +/- 1.1 vs 2.3 +/- 1.0, P < 0.01). Left ventricular (LV) mass and left atrial (LA) volume progressed in the usual care group, but not in the intervention group (P < 0.05). Conclusion. This novel model of care is more effective than conventional care in lowering systolic BP and reducing cardiac and renal end-organ damage in these high-risk patients.