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ACCORD: Intensive BP treatment failed to reduce CV risk in patients with diabetes
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American College of Cardiology 59th Annual Scientific Sessions
ATLANTA – Intensive BP treatment did not reduce the overall risk for CV events in patients with type 2 diabetes, elevated BP and high CV risk when compared with more conventional BP therapy, according to new data from the ACCORD Blood Pressure trial.
Targeting therapy to achieve a BP of <120 mm Hg had no significant effect on the combined rates of nonfatal myocardial infarction, nonfatal stroke or CV death compared with conventional BP control aimed at a systolic BP of <140 mm Hg, researchers said today at the American College of Cardiology 59th Annual Scientific Sessions.
The study included 4,733 patients with type 2 diabetes, high BP and either pre-existing CVD or a high risk for developing CVD. Researchers randomly assigned patients to a target systolic BP of either <120 mm Hg or <140 mm Hg, plus a wide variety of BP-lowering medications to achieve therapeutic goals.
After one year, systolic BP levels averaged 119 mm Hg in the intensive-therapy group compared with 133.5 mm Hg in the standard-therapy group.
After a mean five years of follow-up, the researchers observed no significant between-group differences in the combined rate of nonfatal MI, nonfatal stroke or CV death. The annual rate of the primary outcome was 1.87% in the intensive-therapy group vs. 2.09% in the standard-therapy group (HR=0.88; 95% CI, 0.73-1.06). Rate of death from any cause was 1.28% with intensive therapy and 1.19% with standard therapy (HR=1.07; 95% CI, 0.85-1.35).
At five years, the risk for stroke, a secondary outcome, was significantly lower in the intensive-therapy group (36 strokes vs. 62 strokes). Further, the annual rate of stroke was 0.32% in the intensive-therapy group vs. 0.53% in the standard-therapy group (HR=0.59; 95% CI, 0.39-0.89).
“Intensive therapy did not show a benefit in getting the systolic BP down to 120 mm Hg, even though there was an effect on secondary outcome,” William C. Cushman, MD, chief of the preventive medicine section, Veterans Affairs Medical Center, Memphis, TN, said at a press conference.
Although the stroke results were expected, the researchers said, they were surprised at no demonstrated benefit on overall CV events.
More serious adverse events were reported with intensive therapy compared with standard therapy (77 events vs. 30 events; P<.001). Some laboratory measures of kidney function were worse in the intensive-therapy group, but there was no difference in rates of kidney failure.
“Despite an increased risk of serious adverse events, the results for stroke suggest patients like those in ACCORD may benefit from a systolic BP goal of 120 mm Hg,” Cushman said in a press release.
These data were also published today in the New England Journal of Medicine. – by Katie Kalvaitis
It seems that this is almost like déjà vu all over again. Most of us have been teaching for many years that the lower the BP, the better the outcomes; therefore, seek to get the BP lower. The problem is the dichotomy or differences between what we see and observe epidemiologically. The data we have suggest that we still cannot recommend bringing BP down to <120 mm Hg as a way of reducing risk. I suspect that we have to examine that over a period of time. We need to look further an see if we can find some differences in subgroups that may explain this non-positive result.
– Elijah Saunders, MD
Cardiology Today Editorial Board member
For more information:
- Cushman WC. LBCT I. Presented at: American College of Cardiology 59th Annual Scientific Sessions; March 13-16, 2010; Atlanta.
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