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Randomized Controlled Trial
. 2012 Jul;35(7):1401-5.
doi: 10.2337/dc11-1827.

Intensive blood pressure treatment does not improve cardiovascular outcomes in centrally obese hypertensive individuals with diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure Trial

Joshua I Barzilay  1 , Annie G Howard, Gregory W Evans, Jerome L Fleg, Robert M Cohen, Gillian L Booth, Angela R Kimel, Carolyn F Pedley, William C Cushman
Affiliations
Randomized Controlled Trial

Intensive blood pressure treatment does not improve cardiovascular outcomes in centrally obese hypertensive individuals with diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure Trial

Joshua I Barzilay et al. Diabetes Care. 2012 Jul.

Abstract

Objective: The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure Trial reported no differences in most cardiovascular disease (CVD) outcomes between intensive and standard blood pressure therapy in individuals with diabetes mellitus (DM) and hypertension. Many such individuals are centrally obese. Here we evaluate whether the trial outcomes varied by the level of central obesity.

Research design and methods: The cohort included 4,687 people (47.7% women) with DM and hypertension. Mean age was 62.2, and mean follow-up was 4.7 years. Participants were randomly assigned to one of two blood pressure treatment strategies: intensive (systolic <120 mmHg) or standard (systolic <140 mmHg). Sex-specific quartiles of waist-to-height ratio were used as the measure of central obesity. The primary ACCORD outcome (a composite of nonfatal myocardial infarction [MI], nonfatal stroke, or CVD death) and three secondary outcomes (nonfatal MI, fatal or nonfatal stroke, and CVD death) were examined using proportional hazard models.

Results: There was no evidence that the effect of intensively lowering blood pressure differed by quartile of waist-to-height ratio for any of the four outcomes (P > 0.25 in all cases). Controlling for waist-to-height quartile had no significant impact on previously published results for intensive blood pressure therapy. Waist-to-height ratio was significantly related to CVD mortality (hazard ratio 2.32 [95% CI 1.40-3.83], P = 0.0009 comparing the heaviest to lightest quartiles), but not to the other outcomes (P > 0.09 in all cases).

Conclusions: Intensive lowering of blood pressure versus standard treatment does not ameliorate CVD risk in individuals with DM and hypertension. These results did not vary by quartile of waist-to-height ratio.

Trial registration: ClinicalTrials.gov NCT00000620.

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Figure 1
Figure 1
Comparison of CVD outcomes by level of central obesity in the ACCORD Blood Pressure Trial. BP, blood pressure; INT, intensive; STD, standard.
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References

    1. Canoy D, Luben R, Welch A, et al. Fat distribution, body mass index and blood pressure in 22,090 men and women in the Norfolk cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk) study. J Hypertens 2004;22:2067–2074 - PubMed
    1. Wofford MR, Hall JE. Pathophysiology and treatment of obesity hypertension. Curr Pharm Des 2004;10:3621–3637 - PubMed
    1. Tuomilehto J, Rastenyte D, Birkenhäger WH, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. Systolic Hypertension in Europe Trial Investigators N Engl J Med 1999;340:677–684 - PubMed
    1. ACCORD Study Group. Cushman WC, Evans GW, Byington RP, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010;362:1575–1585 - PMC - PubMed
    1. Buse JB, Bigger JT, Byington RP, et al. ACCORD Study Group Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial: design and methods. Am J Cardiol 2007;99(Suppl.):21i–33i - PubMed

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