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All-cause, CV mortality similar with intensive vs. standard BP lowering in diabetes
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Intensive blood-pressure lowering in adults with type 2 diabetes or an increased 10-year cardiovascular risk may not be more effective at reducing CV and all-cause mortality compared with standard BP lowering, study data show.
Tom F. Brouwer, MD, of the Heart Center in the department of clinical and experimental cardiology at Amsterdam Medical Center at the University of Amsterdam, and colleagues evaluated data from the ACCORD-BP and SPRINT trials on 14,094 adults (mean age, 66 years; 39.7% women) with or without type 2 diabetes to determine the effect of intensive BP lowering on CV events. Researchers also sought to determine the relationship between type 2 diabetes and baseline CVD risk and the treatment effect of intensive BP lowering because people with type 2 diabetes often have an increased 10-year CVD risk compared with those without diabetes. Follow-up was a median 3.26 years.
Participants in both studies were randomly assigned to a systolic BP target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). At baseline, mean systolic BP was 139.5 mm Hg among all participants, 33.6% had type 2 diabetes and the median 10-year risk for CVD was 25%.
Unstable angina, myocardial infarction, acute heart failure, stroke and CV death were included in the composite primary endpoint.
During follow-up, the incidence of the primary endpoint was 7.3% in the pooled cohort; incidence was 8% in participants in the intensive treatment group and 6.6% in participants in the standard treatment group. CV mortality and all-cause mortality were not significantly lower in the intensive treatment group compared with the standard treatment group.
Participants with type 2 diabetes were more likely to experience the primary endpoint compared with participants without type 2 diabetes (9.8% vs. 6%; P < .001). Among participants with type 2 diabetes, those in the intensive treatment group had a lower event rate compared with those in the standard treatment group, but the difference was not significant.
Among participants without a history of CV events, the calculated baseline risk for CVD was higher among those with type 2 diabetes than those without type 2 diabetes (median, 32% vs. 22%; P < .001).
The intensive treatment group was more likely to experience BP-lowering therapy-related serious adverse events than the standard treatment group (6.5% vs. 4.6%; P < .001).
“These analyses do not provide any evidence for a differential effect of intensive blood-pressure lowering in patients with [type 2 diabetes] or a higher 10-year risk [for] cardiovascular disease.” – by Amber Cox
Disclosures: The authors report no relevant financial disclosures.
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