Physicians' Academy for Cardiovascular Education

Intensive BP control benefits diabetic patients at high CV risk

Intensive Versus Standard Blood Pressure Control in SPRINT-Eligible Participants of the ACCORD-BP Trial

Buckley LF, Dixon DL, Wohlford IV GF, et al. - Diabetes Care 2017; published online ahead of print

Background

In the ACCORD-BP study, an SBP of <120 mmHg did not significantly reduce the composite of CVD death, non-fatal MI, and non-fatal stroke compared with a standard SBP goal of <140 mmHg [1]. In the SPRINT study however, a significant reduction was seen in the number of CVD events with intensive BP control to a target SBP of <120 mmHg, although T2DM patients were excluded [2]. The discrepancy might be explained by the different non-DM risk profiles of patients enrolled in the 2 studies.

In this analysis, patients from the ACCORD-BP study with CVD risk factors that would have been eligible for the SPRINT study were identified, and the hypothesis was tested that intensive BP control reduces CVD risk in these patients. For this purpose, the SPRINT inclusion criteria were applied to the ACCORD-BP cohort. This led to a SPRINT-eligible ACCORD-BP population of 2592 participants with the following characteristics:

Subsequently, ACCORD-BP participants in the intensive glucose control arm were excluded from the analysis, because they had an HbA1c goal of <6.0%, which is not recommended by current guidelines as standard of care [3]. Ultimately, 652 participants were left in the intensive BP control arm and 632 participants were left in the standard BP control arm.

Main results

Conclusion

In an SPRINT-eligible ACCORD-BP population, a high-risk cohort of diabetic patients, intensive BP control reduced CVD outcomes. These results support the rational use of an intensive BP control strategy in select, high-risk T2DM patients.

References

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Find this article online at Diabetes Care