Effects of intensive blood-pressure control in type 2 diabetes mellitus
- PMID: 20228401
- PMCID: PMC4123215
- DOI: 10.1056/NEJMoa1001286
Effects of intensive blood-pressure control in type 2 diabetes mellitus
Abstract
Background: There is no evidence from randomized trials to support a strategy of lowering systolic blood pressure below 135 to 140 mm Hg in persons with type 2 diabetes mellitus. We investigated whether therapy targeting normal systolic pressure (i.e., <120 mm Hg) reduces major cardiovascular events in participants with type 2 diabetes at high risk for cardiovascular events.
Methods: A total of 4733 participants with type 2 diabetes were randomly assigned to intensive therapy, targeting a systolic pressure of less than 120 mm Hg, or standard therapy, targeting a systolic pressure of less than 140 mm Hg. The primary composite outcome was nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The mean follow-up was 4.7 years.
Results: After 1 year, the mean systolic blood pressure was 119.3 mm Hg in the intensive-therapy group and 133.5 mm Hg in the standard-therapy group. The annual rate of the primary outcome was 1.87% in the intensive-therapy group and 2.09% in the standard-therapy group (hazard ratio with intensive therapy, 0.88; 95% confidence interval [CI], 0.73 to 1.06; P=0.20). The annual rates of death from any cause were 1.28% and 1.19% in the two groups, respectively (hazard ratio, 1.07; 95% CI, 0.85 to 1.35; P=0.55). The annual rates of stroke, a prespecified secondary outcome, were 0.32% and 0.53% in the two groups, respectively (hazard ratio, 0.59; 95% CI, 0.39 to 0.89; P=0.01). Serious adverse events attributed to antihypertensive treatment occurred in 77 of the 2362 participants in the intensive-therapy group (3.3%) and 30 of the 2371 participants in the standard-therapy group (1.3%) (P<0.001).
Conclusions: In patients with type 2 diabetes at high risk for cardiovascular events, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, did not reduce the rate of a composite outcome of fatal and nonfatal major cardiovascular events. (ClinicalTrials.gov number, NCT00000620.)
2010 Massachusetts Medical Society
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Comment in
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ACCORD and Risk-Factor Control in Type 2 Diabetes.N Engl J Med. 2010 Apr 29;362(17):1628-30. doi: 10.1056/NEJMe1002498. Epub 2010 Mar 14. N Engl J Med. 2010. PMID: 20228405 No abstract available.
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Therapeutics. Intensive blood pressure control did not prevent major CV events more than standard control in type 2 diabetes.Ann Intern Med. 2010 Jul 20;153(2):JC1-4, JC1-5. doi: 10.7326/0003-4819-153-2-201007200-02004. Ann Intern Med. 2010. PMID: 20643982 No abstract available.
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Intensive lowering of systolic blood pressure to a target of less than 120 mm Hg has no effect on the rate of fatal and non-fatal major cardiovascular events in high-risk patients with type 2 diabetes.Evid Based Med. 2010 Oct;15(5):142-3. doi: 10.1136/ebm1099. Epub 2010 Jul 28. Evid Based Med. 2010. PMID: 20667901 No abstract available.
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Blood pressure control in type 2 diabetes.N Engl J Med. 2010 Aug 12;363(7):695; author reply 697. doi: 10.1056/NEJMc1006411. N Engl J Med. 2010. PMID: 20701534 No abstract available.
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Optimal blood pressure for a patient with type 2 diabetes mellitus: insight from the ACCORD study.Curr Hypertens Rep. 2010 Oct;12(5):313-5. doi: 10.1007/s11906-010-0145-z. Curr Hypertens Rep. 2010. PMID: 20725808 No abstract available.
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Blood pressure control in type 2 diabetes.N Engl J Med. 2010 Aug 12;363(7):695-6; author reply 697. doi: 10.1056/NEJMc1006411. N Engl J Med. 2010. PMID: 20842774 No abstract available.
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Blood pressure control in type 2 diabetes.N Engl J Med. 2010 Aug 12;363(7):696; author reply 697. doi: 10.1056/NEJMc1006411. N Engl J Med. 2010. PMID: 20842775 No abstract available.
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Blood pressure control in type 2 diabetes mellitus.Am J Kidney Dis. 2010 Dec;56(6):1029-31. doi: 10.1053/j.ajkd.2010.08.007. Epub 2010 Sep 25. Am J Kidney Dis. 2010. PMID: 20870328 Free PMC article. No abstract available.
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Discord from ACCORD?Curr Hypertens Rep. 2011 Feb;13(1):1-4. doi: 10.1007/s11906-010-0159-6. Curr Hypertens Rep. 2011. PMID: 20963517 No abstract available.
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[Cardiovascular risk in type 2 diabetes. ACCORD study (Action to Control Cardiovascular Risk in Diabetes)].Internist (Berl). 2011 May;52(5):601-4. doi: 10.1007/s00108-011-2843-2. Internist (Berl). 2011. PMID: 21455685 German. No abstract available.
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Blood pressure targets in patients with diabetes--a new perspective.J Am Soc Hypertens. 2015 May;9(5):334-6. doi: 10.1016/j.jash.2015.03.003. Epub 2015 Mar 16. J Am Soc Hypertens. 2015. PMID: 25979409 No abstract available.
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