Effect of intensive blood pressure control in patients with type 2 diabetes mellitus over 9 years of follow-up: A subgroup analysis of high-risk ACCORDION trial participants.
Pubmed ID: 29424469
Journal: Diabetes, obesity & metabolism
Publication Date: 06/01/2018
Affiliation: Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, Virginia.
MeSH Terms: Humans, Male, Female, Aged, Middle Aged, Hypertension, Heart Failure, Follow-Up Studies, Stroke, Diabetic Angiopathies, Double-Blind Method, Myocardial Infarction, Diabetes Mellitus, Type 2, Antihypertensive Agents, Angina, Unstable
Authors: Buckley LF, Dixon DL, Wohlford GF, Wijesinghe DS, Baker WL, Van Tassell BW
Cite As: Buckley LF, Dixon DL, Wohlford GF 4th, Wijesinghe DS, Baker WL, Van Tassell BW. Effect of intensive blood pressure control in patients with type 2 diabetes mellitus over 9 years of follow-up: A subgroup analysis of high-risk ACCORDION trial participants. Diabetes Obes Metab 2018 Jun;20(6):1499-1502. Epub 2018 Mar 2.
Although guidelines recommend strict blood pressure (BP) control in patients with type 2 diabetes mellitus (T2DM) and elevated cardiovascular risk, the long-term effects of this approach are unknown. We investigated the effect of intensive BP control on clinical outcomes in patients with T2DM over 9 years of follow-up. We included Action to Control Cardiovascular Risk in Diabetes - Blood Pressure participants in the standard glucose control arm who had established cardiovascular disease, chronic kidney disease, were ≥75 years of age or who had a 10-year coronary heart risk ≥15%. Participants were randomized to either intensive (systolic BP < 120 mm Hg) or standard (systolic BP < 140 mm Hg) BP control for an average of 5 years. Observational follow-up occurred for an average of 4 years thereafter. After an average total follow-up of 9 years, intensive BP control reduced the composite of cardiovascular death, nonfatal myocardial infarction and nonfatal stroke by 25% (hazard ratio, 0.75; 95% confidence interval, 0.60-0.95; P = .02). The overall benefit was driven by a reduction in nonfatal myocardial infarction (P = .01). In this post-hoc analysis, the benefits of a fixed-duration intensive BP control intervention in patients with T2DM persisted throughout 9 years of follow-up.