Key result
Intensive systolic blood pressure lowering in patients with type 2 diabetes did not significantly reduce overall cardiovascular events (HR 0.88; 95% CI 0.73-1.06; P=0.20) but reduced cerebrovascular disease.
Why the study?
Does intensive systolic blood pressure-lowering treatment reduce cardiovascular events in patients with type 2 diabetes mellitus?
Does intensive systolic blood pressure-lowering treatment reduce cardiovascular events in patients with type 2 diabetes mellitus?
Hazard Ratio: 0.88 (95% CI 0.73–1.06)
p-value: p=0.20
Intensive blood pressure lowering in patients with type 2 diabetes significantly reduces the risk of cerebrovascular disease, even if it does not significantly reduce overall cardiovascular events.
Hypertension is widely recognized as an important cardiovascular disease (CVD) risk in patients with type 2 diabetes mellitus (T2DM). The ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial investigated whether there would be a difference in CVD-event reduction between an intensive systolic blood pressure (SBP)-lowering treatment (targeting SBP < 120 mm Hg) and the standard treatment (targeting SBP < 140 mm Hg) in hypertensives with T2DM. The trial showed no significant difference in cardiovascular events or all-cause mortality between the intensive treatment (mean SBP: 119.3 mm Hg) and the standard treatment (mean SBP: 133.5 mm Hg); for cardiovascular events and death from cardiovascular causes: hazard ratio = 0.88, 95% confidence interval = 0.73-1.06, P = 0.20. However, it was notable that most of the cardiovascular events observed in that study involved coronary artery disease (CAD), but the prevalence of cerebrovascular disease was significantly reduced in the intensive-treatment group: hazard ratio = 0.59, 95% confidence interval = 0.39-0.89, P = 0.01. 1 Furthermore, Reboldi et al. conducted a meta-analysis of randomized control trials that included a total of 73,913 diabetic patients. Their findings indicated that the tight control of SBP at <130 mm Hg significantly decreased the relative risk of cerebrovascular disease (relative risk = 0.61, 95% confidence interval = 0.48-0.79, P = 0.003), although such control was not significant for CAD. These results suggest that intensive blood pressure (BP)-lowering therapy provides benefits for the reduction of cardiovascular events even among individuals with T2DM. Although the results of these studies in patients with T2DM also indicate that intensive management of hypertension might be useful for prevention of CVD in patients with type 1 diabetes mellitus (T1DM), the precise BP levels that constitute a CVD risk in T1DM remain to be established.
No takes yet. Share an insight, caveat, or question.
Narita et al. (2019) conducted a review in Type 2 diabetes mellitus and hypertension. Intensive systolic blood pressure-lowering treatment vs. Standard treatment (targeting SBP < 140 mm Hg) was evaluated on Cardiovascular events and death from cardiovascular causes (HR 0.88, 95% CI 0.73-1.06, p=0.20). Intensive systolic blood pressure lowering in patients with type 2 diabetes did not significantly reduce overall cardiovascular events (HR 0.88; 95% CI 0.73-1.06; P=0.20) but reduced cerebrovascular disease.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: