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J Am Heart Assoc. 2018 Sep 18;7(18):e009326. doi: 10.1161/JAHA.118.009326.

Effects of Intensive Systolic Blood Pressure Lowering on Cardiovascular Events and Mortality in Patients With Type 2 Diabetes Mellitus on Standard Glycemic Control and in Those Without Diabetes Mellitus: Reconciling Results From ACCORD BP and SPRINT.

Author information

1
1 Medical Service Veterans Affairs Salt Lake City Health Care System Salt Lake City UT.
2
2 Division of Nephrology & Hypertension University of Utah School of Medicine Salt Lake City UT.
3
5 Division of Nephrology Stanford University School of Medicine Palo Alto CA.
4
3 Division of Biostatistics University of Utah School of Medicine Salt Lake City UT.
5
6 Tulane University School of Public Health and Tropical Medicine New Orleans LA.
6
7 Department of Biostatistical Sciences Wake Forest School of Medicine Winston-Salem NC.
7
8 National Heart, Lung and Blood Institute Bethesda MD.
8
9 Division of Nephrology and Hypertension Departments of Public Health Sciences and Medicine Loyola University Chicago Maywood IL.
9
10 Hines Veteran's Affairs Medical Center Hines IL.
10
4 Division of Health System Innovation and Research Department of Population Health Sciences University of Utah School of Medicine Salt Lake City UT.
11
11 National Institute of Diabetes, Digestive and Kidney Diseases Bethesda MD.
12
12 Division of Cardiovascular Disease Department of Medicine University of Alabama at Birmingham AL.
13
13 Department of Epidemiology, School of Public Health University of Alabama at Birmingham AL.
14
14 Case Western Reserve University Cleveland OH.
15
15 Veterans Affairs Medical Center Memphis TN.

Abstract

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.

KEYWORDS:

cardiovascular outcomes; diabetes mellitus; high blood pressure; hypertension

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