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Intensive BP therapy may lower CVD odds in type 2 diabetes
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Intensive BP treatment may be beneficial for patients with type 2 diabetes, even when levels of BP and risk for CVD are lower than recommended for treatment, according to findings published in Hypertension.
Faisal Rahman, BM BCh, MA, and colleagues sought to determine whether benefits and risks of intensified antihypertensive therapy in patients with diabetes are influenced by baseline BP or CVD risk.
“The blood pressure threshold for initiation of antihypertensive treatment among patients with diabetes mellitus remains controversial,” Rahman, a cardiology fellow in the division of cardiology and the department of medicine at the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins University School of Medicine, and colleagues wrote. “This uncertainty complicates the care of these patients because the risk of future cardiovascular events associated with the presence of diabetes mellitus is considered equivalent to that of people who have previously had a myocardial infarction.”
Efficacy of perindopril, indapamide
The researchers analyzed data from 10,948 patients with diabetes from the ADVANCE trial at moderate to high risk for CVD.
Rahman and colleagues determined whether baseline BP category or CVD risk modified outcomes of treatment of perindopril-indapamide compared with placebo.
During a 4.3-year follow-up period, the perindopril-indapamide treatment reduced major vascular events (HR = 0.91; 95% CI, 0.83-0.997) and all-cause mortality (HR = 0.86; 95% CI, 0.75-0.99) compared with placebo, the researchers wrote.
The researchers observed no difference in treatment effect, regardless of baseline systolic BP as far down as < 120 mm Hg or diastolic BP as far down as < 70 mm Hg and regardless of whether 10-year CVD risk was 20% or greater or less than 20% (P .08 for all).
The effects of stratified treatment on discontinuation of treatment because of cough or hypotension were also statistically consistent across subgroups defined by baseline BP and risk for CVD (P .08 for all), Rahman and colleagues wrote.
“Our findings demonstrate a benefit of more intensive therapy aiming for blood pressure thresholds at 130/80 or below should help resolve some ongoing confusion over optimal blood pressure targets for people with diabetes,” J. William (Bill) McEvoy, MB BCh, MHS, professor of preventive cardiology at the National University of Ireland and the Irish National Institute for Preventive Cardiology and a Cardiology Today Next Gen Innovator, who was with the Johns Hopkins University School of Medicine when the study was conducted, said in a press release.
Facing an urgent task
In a related editorial, Eduardo Sanchez, MD, MPH, the chief medical officer for prevention and chief of the Centers for Health Metrics and Evaluation with the American Heart Association, wrote: “As we face the urgent task of stopping what appears to be reversal in decades-long decline in mortality from coronary heart disease and stroke, especially in some population groups, the millions of people who have both diabetes and hypertension are a key focus. This new study provides important data to indicate that people with diabetes to moderate to high risk would benefit from more intensive blood pressure treatment, in the form of a reduction in all-cause mortality and major vascular events (which includes cardiovascular death). – by Earl Holland Jr.
Disclosures: McEvoy and Rahman report no relevant financial disclosures. Sanchez is an employee of the AHA. Please see the study for all other authors’ relevant financial disclosures.
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