Intensive SBP lowering (<120 mm Hg) similarly reduced CVD events in patients without diabetes (HR 0.75; 95% CI 0.64-0.89) and with diabetes on standard glycemic control (HR 0.77; 95% CI 0.63-0.95).
RCT
2x2 factorial
Does intensive SBP lowering reduce composite CVD events and all-cause mortality in patients with type 2 diabetes on standard glycemic control and those without diabetes?
Intensive SBP lowering provides similar cardiovascular benefits in patients without diabetes and those with diabetes on standard glycemic control, suggesting that the lack of benefit in the overall ACCORD BP trial may have been due to an interaction with intensive glycemic control.
Hazard Ratio: 0.75 (95% CI 0.64–0.89)
Background Intensive systolic blood pressure ( SBP ) lowering significantly reduced cardiovascular disease ( CVD ) events in SPRINT (Systolic Blood Pressure Intervention Trial) but not in ACCORD BP (Action to Control Cardiovascular Risk in Diabetes Blood Pressure). Methods and Results SPRINT tested the effects of intensive (<120 mm Hg) versus standard (<140 mm Hg) SBP goals on CVD events and all-cause mortality. Using 2×2 factorial design, ACCORD BP tested the same SBP intervention in addition to an intensive versus standard glycemia intervention. We compared the effects of intensive SBP lowering on the composite CVD end point and all-cause mortality in SPRINT with its effects within each of the glycemia arms in ACCORD BP . Intensive SBP lowering decreased the hazard of the composite CVD end point similarly in SPRINT (hazard ratio: 0.75; 95% confidence interval, 0.64-0.89) and in the ACCORD BP standard glycemia arm (hazard ratio: 0.77; 95% confidence interval, 0.63-0.95; interaction P=0.87). However, the effect of intensive SBP lowering on the composite CVD end point in the ACCORD BP intensive glycemia arm (hazard ratio: 1.04; 95% confidence interval, 0.83-1.29) was significantly different from SPRINT (interaction P=0.023). Patterns were similar for all-cause mortality. Conclusions The effects of intensive SBP control on CVD events and all-cause mortality were similar in patients without diabetes mellitus and in those with diabetes mellitus on standard glycemic control. An interaction between intensive SBP lowering and intensive glycemic control may have masked beneficial effects of intensive SBP lowering in ACCORD BP . Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifiers: NCT 01206062, NCT 00000620.
Beddhu et al. (Tue,) conducted a rct in Type 2 Diabetes Mellitus and Hypertension. Intensive systolic blood pressure lowering vs. Standard SBP goal (<140 mm Hg) was evaluated on Composite CVD end point (HR 0.75, 95% CI 0.64-0.89). Intensive SBP lowering (<120 mm Hg) similarly reduced CVD events in patients without diabetes (HR 0.75; 95% CI 0.64-0.89) and with diabetes on standard glycemic control (HR 0.77; 95% CI 0.63-0.95).