Intensive blood pressure lowering reduced the incidence of the composite outcome of atrial fibrillation and P-wave indices compared to standard therapy (HR 0.87; 95% CI 0.77-0.98; P=0.02).
RCT (n=3,087)
Open-label
Randomized
Effect estimate: HR 0.87 (95% CI 0.77-0.98)
Absolute Event Rate: 73.9% vs 84.5%
p-value: p=0.02
BACKGROUND: There are no proven strategies to prevent atrial fibrillation (AF) in patients with type 2 diabetes (T2DM). We compared standard blood pressure (BP) lowering vs. intensive BP lowering in reducing incidence of AF or P-wave indices (PWI-ECG markers of left atrial abnormality that are considered intermediate phenotypes of AF) in patients with T2DM. METHODS: We analyzed data from the ACCORD BP trial-a randomized controlled nonblinded trial (2001-2009) which randomized patients with T2DM and systolic BP (SBP) 130-180mm Hg on ≤3 antihypertensive medications aged 40-79 years with cardiovascular disease (CVD) or aged 55-79 years with subclinical CVD or ≥2 CVD risk factors to standard BP lowering (SBP <140mm Hg) vs. intensive BP lowering (SBP <120mm Hg). The primary outcome was a composite of incident AF and PWI. RESULTS: Data from 3,087 participants (mean age, 62.2 years; women, 48.2%; non-White, 39.2%) were analyzed. During a mean follow-up of 4.4 years, the primary outcome occurred in 1,063 participants (incidence rate, 84.5 per 1,000 person-years in the standard-therapy group vs. 73.9 per 1,000 person-years in the intensive-therapy group). The adjusted hazard ratios (95% confidence intervals) of intensive-therapy group for the primary outcome and for incident PWI alone were 0.87 (0.77-0.98), P = 0.02 and 0.87 (0.76-0.98), P = 0.02, respectively. The effect of intensive therapy on the incidence of AF alone did not reach statistical significance. CONCLUSIONS: In patients with T2DM, intensive BP lowering reduces the incidence of the composite outcome of AF and PWI, suggesting a potential benefit from stringent BP control in patients with T2DM. clinical trials registration Trial Number NCT00000620.
Chen et al. (Fri,) conducted a rct in Type 2 diabetes (T2DM) (n=3,087). Intensive BP lowering vs. Standard BP lowering (SBP <140mm Hg) was evaluated on Composite of incident AF and PWI (HR 0.87, 95% CI 0.77-0.98, p=0.02). Intensive blood pressure lowering reduced the incidence of the composite outcome of atrial fibrillation and P-wave indices compared to standard therapy (HR 0.87; 95% CI 0.77-0.98; P=0.02).
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