Intensive blood pressure lowering to an SBP target of <120 mmHg significantly reduced cardiovascular events compared to a <140 mmHg target (HR 0.82; 95% CI 0.73-0.93; P=0.0017), regardless of T2DM.
Meta-Analysis (n=14,094)
Randomized
Does intensive blood pressure lowering (SBP target <120 mmHg) reduce cardiovascular events in hypertensive patients with and without type 2 diabetes compared to a target of <140 mmHg?
Intensive blood pressure lowering to <120 mmHg significantly reduces cardiovascular events similarly in hypertensive patients with and without type 2 diabetes.
Effect estimate: HR 0.82 (95% CI 0.73-0.93)
p-value: p=0.0017
OBJECTIVE The Action to Control Cardiovascular Risk in Diabetes Blood Pressure (ACCORD-BP) study did not find a significant beneficial effect of intensive systolic blood pressure (SBP) lowering on cardiovascular events in hypertensive patients with type 2 diabetes mellitus (T2DM), while the Systolic Blood Pressure Intervention Trial (SPRINT) did find a significant beneficial effect in patients without T2DM. The objective of this analysis was to assess the effect of both T2DM and baseline cardiovascular disease risk on the treatment effect of intensive blood pressure lowering. RESEARCH DESIGN AND METHODS The individual patient data from the ACCORD-BP and SPRINT studies were pooled and follow-up durations harmonized. Both studies randomized hypertensive patients to an SBP target of 120 mmHg or a target of 140 mmHg. The composite primary end point consisted of unstable angina, myocardial infarction, acute heart failure, stroke, and cardiovascular death. The interaction between intensive blood pressure lowering and both T2DM and 10-year cardiovascular risk was assessed using Cox proportional hazards models. RESULTS The cohort consisted of 14,094 patients with mean age 66 ± 8.9 years and mean baseline SBP 139.5 ± 15.6 mmHg; 33.6% had T2DM. The hazard ratio for the primary composite end point was 0.82 (95% CI 0.73–0.93), P = 0.0017. The interaction between intensive blood pressure lowering and T2DM was nonsignificant (P = 0.13). The 10-year cardiovascular risk was higher in primary prevention patients with T2DM, but risk did not interact with the treatment effect (P = 0.84). CONCLUSIONS Intensive blood pressure lowering may have a similar favorable effect and appears to decrease cardiovascular events in both patients with and patients without T2DM.
Brouwer et al. (2017) conducted a meta-analysis in Hypertension with and without type 2 diabetes mellitus (n=14,094). Intensive blood pressure lowering vs. SBP target <140 mmHg was evaluated on Composite of unstable angina, myocardial infarction, acute heart failure, stroke, and cardiovascular death (HR 0.82, 95% CI 0.73-0.93, p=0.0017). Intensive blood pressure lowering to an SBP target of <120 mmHg significantly reduced cardiovascular events compared to a <140 mmHg target (HR 0.82; 95% CI 0.73-0.93; P=0.0017), regardless of T2DM.