Intensive BP treatment back on table for diabetes patients
medwireNews: Intensive blood pressure (BP) management benefits patients whether or not they have diabetes and regardless of their baseline level of cardiovascular disease (CVD) risk, shows a pooled analysis of the SPRINT and ACCORD-BP trials.
Researchers led by Tom Brouwer (University of Amsterdam, the Netherlands) pooled individual patient data from 4733 ACCORD-BP participants (all with type 2 diabetes) and 9361 SPRINT participants (none with diabetes). The trials had slightly different primary endpoints, but because the team had the individual patient data, they were able to calculate the rate of the SPRINT primary endpoint for all patients.
This composite endpoint, of myocardial infarction, stroke, cardiovascular death, unstable angina, and acute decompensated heart failure, occurred in 7.3% of the pooled cohort over a median follow-up of 3.26 years. The rate was significantly lower among patients treated to an intensive systolic BP target of less than 120 mmHg, at 6.6%, compared with 8.0% among those treated to the standard target of less than 140 mmHg.
The researchers note that previous studies have suggested no additional benefit in lowering diabetes patients’ BP beyond the standard 140 mmHg target.
But in this analysis, although patients with diabetes had an increased rate of the primary endpoint, at 9.8% versus 6.0% for patients without diabetes, there was no statistical interaction indicating that they derived less benefit from intensive treatment.
Intensive treatment did in fact result in a reduced rate of the primary endpoint among diabetes patients, at 9.4% versus 10.3% with standard treatment. This was not significant, but the researchers note that they had low statistical power and would have required data for around 50,000 patients to detect a difference.
The team also showed that CVD risk did not modify the effect of BP treatment in diabetes patients, despite them having a higher median 10-year CVD risk than patients without diabetes, at 32% versus 22%. Among the 3470 patients with CVD at baseline, intensive versus standard treatment resulted in a nonsignificant reduction in the rate of the primary endpoint.
Current guidelines advocate intensive BP management only in specific groups of diabetes patients, such as those with kidney or cerebrovascular disease. But Brouwer and team believe their findings clear the way to considering intensive BP management for type 2 diabetes patients in general.
“Therefore, tailoring the treatment for the individual patient seems appropriate based on the goals of the individual patient, life expectancy, and the likelihood of the adverse events to occur,” they conclude in Diabetes Care.
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