Generalizing Intensive Blood Pressure Treatment to Adults With Diabetes Mellitus.

Pubmed ID: 30189998

Pubmed Central ID: PMC6358208

Journal: Journal of the American College of Cardiology

Publication Date: Sept. 11, 2018

Affiliation: Center for Primary Care and Outcomes Research, Center for Population Health Sciences, Departments of Medicine and of Health Research and Policy, Stanford University, Palo Alto, California; Center for Primary Care, Harvard Medical School, Boston, Massachusetts.

Link: https://ac.els-cdn.com/S0735109718354743/1-s2.0-S0735109718354743-main.pdf?_tid=237d7b47-027d-4c3b-9da4-9d30368c3b85&acdnat=1540857082_c249312c9fa6010a6e94a4f91af169de&link_time=2024-03-29_11:43:10.798607

MeSH Terms: Humans, Male, Female, United States, Middle Aged, Hypertension, Randomized Controlled Trials as Topic, Proportional Hazards Models, Stroke, Myocardial Infarction, Diabetes Mellitus, Type 2, Health Surveys, Antihypertensive Agents, Death, Sudden, Cardiac

Grants: P30 DK092926, K08 HL121056, U54 MD010724, DP2 MD010478, L30 DK103291, K23 DK109200, IK2 HX001368

Authors: Basu S, Sussman JB, Berkowitz SA, Jonas DE

Cite As: Berkowitz SA, Sussman JB, Jonas DE, Basu S. Generalizing Intensive Blood Pressure Treatment to Adults With Diabetes Mellitus. J Am Coll Cardiol 2018 Sep 11;72(11):1214-1223.

Studies:

Abstract

BACKGROUND: Controversy over blood pressure (BP) treatment targets for individuals with diabetes is in part due to conflicting perspectives about generalizability of available trial data. OBJECTIVE: The authors sought to estimate how results from the largest clinical trial of intensive BP treatment among adults with diabetes would generalize to the U.S. METHODS: The authors used transportability methods to reweight individual patient data from the ACCORD (Action to Control Cardiovascular Risk in Diabetes) BP trial (N = 4,507) of intensive (goal systolic BP <120 mm Hg) versus standard (goal systolic BP <140 mm Hg) treatment to better represent the demographic and clinical risk factors of the U.S. population of adults with diabetes (data from NHANES [National Health and Nutrition Examination Survey] 2005 to 2014, n = 1,943). The primary outcome was the first occurrence of nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. Analysis used weighted Cox proportional hazards regression models with robust standard errors. RESULTS: The ACCORD BP sample had less racial/ethnic diversity and more elevated cardiovascular risk factors than the NHANES participants. Weighted results significantly favored intensive BP treatment, unlike unweighted results (hazard ratio for primary outcome in intensive versus standard treatment in weighted analyses: 0.67, 95% confidence interval: 0.49 to 0.91; in unweighted analyses: hazard ratio: 0.88, 95% confidence interval: 0.73 to 1.07). Over 5 years, the weighted results estimate a number needed to treat of 34, and number needed to harm of 55. CONCLUSIONS: After reweighting to better reflect the U.S. adult population with diabetes, intensive BP therapy was associated with significantly lower risk for cardiovascular events. However, data were limited among racial/ethnic minorities and those with lower cardiovascular risk.