Intensive BP control may be beneficial for high-risk type 2 diabetes patients
medwireNews: A post-hoc analysis of the ACCORD-BP trial suggests that the presence of additional cardiovascular (CV) risk factors may be key for patients with type 2 diabetes to derive benefit from intensive blood pressure (BP) control.
The primary results from ACCORD-BP showed that an intensive BP reduction strategy to achieve systolic BP of less than 120 mmHg did not significantly reduce the risk for CV disease (CVD) events compared with a standard systolic BP goal of less than 140 mmHg among type 2 diabetes patients, explain Benjamin Van Tassell (Virginia Commonwealth University, Richmond, USA) and study co-authors.
The SPRINT trial, on the other hand, found that intensive BP control significantly reduced the risk for CVD events among patients with additional CV risk factors, but the study population did not include those with type 2 diabetes, they add.
In the current analysis, Van Tassell and colleagues analyzed the risk for CV outcomes among the 27.1% of 4733 patients in ACCORD-BP who had additional CV risk factors that would have made them eligible for inclusion in SPRINT, including chronic kidney disease and a 10-year Framingham risk score of at least 15%.
Among participants in this subgroup, the team observed a “large and clinically relevant reduction in CVD outcomes” with intensive versus standard BP control. Patients receiving intensive BP control had a significant 21% reduced risk for the composite outcome of CVD death, nonfatal myocardial infarction, nonfatal stroke, revascularization, and heart failure, with annual rates of 3.48% versus 4.22%.
Patients in the intensive control group also had a lower risk for the individual components of the composite CV outcome compared with those receiving standard BP control, but the differences did not reach statistical significance.
“The risk difference between our study and the overall ACCORD-BP trial population therefore suggests that the benefits of intensive BP control are more pronounced among patients with several CVD risk factors and that the benefits of intensive BP control are a function of CVD risk factors beyond [type 2 diabetes,” write the study authors in Diabetes Care.
Indeed, when the researchers pooled the high-risk patients in ACCORD-BP with the SPRINT participants, the magnitude of reduction in the composite outcome seen with intensive BP control was not significantly different between patients with and without diabetes.
Van Tassell and colleagues note that “[t]he limitations inherent in a post hoc subgroup analysis should be considered when interpreting and applying the results of this analysis,” and that there were “differences in event definitions and data availability between SPRINT and ACCORD-BP.”
“Therefore, all findings from these analyses should be considered hypothesis generating,” they caution.
Nevertheless, the team concludes: “In the absence of a definitive prospective, randomized controlled trial, these results support the judicious use of an intensive BP control strategy in select, high-risk [type 2 diabetes] patients.”
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