Intensive BP control benefits diabetic patients at high CV risk
Intensive Versus Standard Blood Pressure Control in SPRINT-Eligible Participants of the ACCORD-BP TrialLiterature - Buckley LF, Dixon DL, Wohlford IV GF, et al. - Diabetes Care 2017; published online ahead of print
- Intensive BP control significantly reduced the risk of the composite of CVD death, non-fatal MI, non-fatal stroke, any revascularization, or HF by 21% in SPRINT-eligible ACCORD-BP participants (3.48%/year vs. 4.22%/year; HR: 0.79; 95% CI: 0.65 – 0.96; P = 0.02).
- Intensive BP control also significantly reduced the risk of the ACCORD-BP primary end point of CVD death, non-fatal MI, or non-fatal stroke (1.26%/year vs. 1.79%/year; HR: 0.69; 95% CI: 0.51 – 0.93; P = 0.01).
- The risks of non-fatal MI, non-fatal stroke, and HF were favorably influenced by intensive BP control compared with standard BP control, although statistical significance was not reached.
- Treatment-related serious adverse events among SPRINT-eligible ACCORD-BP patients occurred more frequently in intensive BP control participants compared with standard BP control participants (4.1% vs. 2.1%; P = 0.003).
- After pooling the original SPRINT participants with SPRINT-eligible ACCORD-BP participants, there was no evidence of heterogeneity in the effect of intensive BP control between participants with and without T2DM with respect to the composite of CVD death, non-fatal MI, non-fatal stroke, any revascularization, or HF (P = 0.76 for interaction); or the composite of CVD death, non-fatal MI, or non-fatal stroke (P = 0.62 for interaction).
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.