{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T01:23:28Z","timestamp":1761873808524,"version":"build-2065373602"},"reference-count":14,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,2,20]],"date-time":"2018-02-20T00:00:00Z","timestamp":1519084800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003246","name":"Nederlandse Organisatie voor Wetenschappelijk Onderzoek","doi-asserted-by":"publisher","award":["917.15.306"],"award-info":[{"award-number":["917.15.306"]}],"id":[{"id":"10.13039\/501100003246","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2018,6]]},"abstract":"\n Aims<\/jats:title>\n To assess variability in systolic blood pressure (SBP) and albuminuria (urinary albumin creatinine ratio [UACR]) responses in patients with type 2 diabetes mellitus initiating renin angiotensin aldosterone system (RAAS) inhibition, and to assess the association of response variability with cardiovascular outcomes.<\/jats:p>\n <\/jats:sec>\n \n Material and Methods<\/jats:title>\n \n We performed an observational cohort study in patients with type 2 diabetes who started RAAS inhibition between 2007 and 2013 (\n n<\/jats:italic>\n = 1600). Patients were identified from general practices in the Netherlands. Individual response in SBP and UACR was assessed during 15 months\u2019 follow\u2010up. Patients were categorized as: good responders (\u2206SBP <0 mm Hg and \u2206UACR <0%); intermediate responders (\u2206SBP <0 mm Hg and \u2206UACR >0% or \u2206SBP >0 mm Hg and \u2206UACR <0%); or poor responders (\u2206SBP >0 mm Hg and \u2206UACR >0%). Multivariable Cox regression was performed to test the association between initial RAAS inhibition response and subsequent cardiovascular outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n After starting RAAS inhibition, the mean SBP change was \u221213.2 mm Hg and the median UACR was \u221236.6%, with large between\u2010individual variability, both in SBP [5th to 95th percentile: 48.5\u201020] and UACR [5th to 95th percentile: \u221287.6 to 171.4]. In all, 812 patients (51%) were good responders, 353 (22%) had a good SBP but poor UACR response, 268 (17%) had a good UACR but poor SBP response, and 167 patients (10%) were poor responders. Good responders had a lower risk of cardiovascular events than poor responders (hazard ratio 0.51, 95% confidence interval 0.30\u20100.86;\n P<\/jats:italic>\n = .012).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n SBP and UACR response after RAAS inhibition initiation varied between and within individual patients with type 2 diabetes treated in primary care. Poor responders had the highest risk of cardiovascular events, therefore, more efforts are needed to develop personalized treatment plans for these patients.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/dom.13226","type":"journal-article","created":{"date-parts":[[2018,1,18]],"date-time":"2018-01-18T07:05:19Z","timestamp":1516259119000},"page":"1377-1383","source":"Crossref","is-referenced-by-count":8,"title":["Individual variability in response to renin angiotensin aldosterone system inhibition predicts cardiovascular outcome in patients with type 2 diabetes: A primary care cohort study"],"prefix":"10.1111","volume":"20","author":[{"given":"Ellen M.","family":"Apperloo","sequence":"first","affiliation":[{"name":"University of Groningen, University Medical Centre Groningen Department of Clinical Pharmacy and Pharmacology Groningen The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3340-2893","authenticated-orcid":false,"given":"Michelle J.","family":"Pena","sequence":"additional","affiliation":[{"name":"University of Groningen, University Medical Centre Groningen Department of Clinical Pharmacy and Pharmacology Groningen The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dick","family":"de Zeeuw","sequence":"additional","affiliation":[{"name":"University of Groningen, University Medical Centre Groningen Department of Clinical Pharmacy and Pharmacology Groningen The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petra","family":"Denig","sequence":"additional","affiliation":[{"name":"University of Groningen, University Medical Centre Groningen Department of Clinical Pharmacy and Pharmacology Groningen The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3126-3730","authenticated-orcid":false,"given":"Hiddo J. L.","family":"Heerspink","sequence":"additional","affiliation":[{"name":"University of Groningen, University Medical Centre Groningen Department of Clinical Pharmacy and Pharmacology Groningen The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,2,20]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11154-017-9422-3"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000139860.33974.28"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.12600"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc07-0960"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr017"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.3317\/jraas.2002.042"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2006050445"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc11-0324"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.1230"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e31817924d2"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(96)00268-5"},{"key":"e_1_2_6_13_1","unstructured":"Groningen Initiative to Analyse Type 2 diabetes Treatment (GIANTT). GIANTT website.https:\/\/www.giantt.nl\/en\/. Accessed February 6 2018."},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI23378"},{"issue":"12","key":"e_1_2_6_15_1","doi-asserted-by":"crossref","first-page":"835","DOI":"10.7326\/0003-4819-159-12-201312170-00726","article-title":"Clinical Guidelines Committee of the American College of Physicians. Screening, monitoring, and treatment of stage 1 to 3 chronic kidney disease: a clinical practice guideline from the American College of Physicians","volume":"159","author":"Qaseem A","year":"2013","journal-title":"Ann Intern Med"}],"container-title":["Diabetes, Obesity and Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fdom.13226","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/dom-pubs.pericles-prod.literatumonline.com\/doi\/pdf\/10.1111\/dom.13226","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T01:16:42Z","timestamp":1761873402000},"score":1,"resource":{"primary":{"URL":"https:\/\/dom-pubs.pericles-prod.literatumonline.com\/doi\/10.1111\/dom.13226"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,20]]},"references-count":14,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2018,6]]}},"alternative-id":["10.1111\/dom.13226"],"URL":"https:\/\/doi.org\/10.1111\/dom.13226","archive":["Portico"],"relation":{},"ISSN":["1462-8902","1463-1326"],"issn-type":[{"type":"print","value":"1462-8902"},{"type":"electronic","value":"1463-1326"}],"subject":[],"published":{"date-parts":[[2018,2,20]]}}}