Study Questions Value of Low Systolic Blood Pressure Goal in Patients With Diabetes
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Targeting a normal systolic blood pressure (i.e., <120 mm Hg) in high-risk patients with type 2 diabetes does not reduce major cardiovascular events and may even be harmful, based on results from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure trial (ACCORD BP).
ACCORD was a randomized clinical trial that enrolled more than 10,000 patients with type 2 diabetes at 77 sites in the United States and Canada. All participants were deemed to be at high risk of a major cardiovascular event. In the nonblinded ACCORD BP trial, 4,733 ACCORD participants who had a systolic blood pressure between 130 and 180 mm Hg and were taking three or fewer antihypertensive medications were randomly assigned to intensive therapy (target systolic pressure <120 mm Hg) or standard therapy (target systolic pressure <140 mm Hg). The specific treatment strategy was left to the discretion of the patient’s study physician.
The primary composite outcome was the first occurrence of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. Patients were followed for a mean of 4.7 years.
After the first year of therapy, the mean systolic pressure was 119.3 mm Hg in the intensive group and 133.5 mm Hg in the standard group. The primary composite outcome occurred in 445 participants; the rate was 1.87% per year in the intensive group and 2.09% per year in the standard group—a difference that was not significant. The annual rates of death from any cause (1.28% in the intensive group and 1.19% in standard group) also did not differ significantly. However, the rate of serious adverse events attributed to antihypertensive treatment was significantly higher in the intensive group (3.3%) than in the standard group (1.3%).
N Engl J Med. 2010 Mar 14.