In patients with diabetes and hypertension, is intensive bloop pressure control more effective than non-intensive blood pressure control in reducing nonfatal MI, nonfatal stroke, or CV mortality?
Why we should know it: In patients with T2DM at high risk for CV events, targeting SBP <120 mmHg did not reduce rates of nonfatal MI, nonfatal stroke, or CV mortality when compared to a target SBP <140 mmHg.
Intensive BP control did not significantly reduce the primary cardiovascular outcome or the rate of death from any cause, nor most of the secondary trial outcomes (at p<0.05, intensive BP management did not reduce rate of total stroke or nonfatal stroke) despite the fact that there was a significant and sustained difference between the intensive-therapy group and the standard-therapy group in mean systolic blood pressure
Overview: 77 sites with 10,000 patients in the US split into 3 groups - the ACCORD-Glycemia (A1c), ACCORD-BP, and the ACCORD-Lipid trials. Controlled BP in type two diabetics for <120 or <140 in two groups, looking at nonfatal MI, nonfatal stroke, or death from cardiovascular causes. They followed up for ~5years.
Shortcomings
Other notes: Hazard Ratio vs RRR
2017 ACC AHA AAPA ABC ACPM AGS APhA ASH ASPC NMA PCNA Hypertension (2017, adapted)
ACCORD Study Group. "Effects of intensive blood-pressure control in type 2 diabetes mellitus". The New England Journal of Medicine. 2010. 362(17):1575-1585.
https://www.ncbi.nlm.nih.gov/pubmed/20228401
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