Effects of Intensive Systolic Blood Pressure Lowering on Cardiovascular Events and Mortality in Patients With Type 2 Diabetes Mellitus on Standard Glycemic Control and in Those Without Diabetes Mellitus: Reconciling Results From ACCORD BP and SPRINT.

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  • Additional Information
    • Source:
      Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101580524 Publication Model: Print Cited Medium: Internet ISSN: 2047-9980 (Electronic) Linking ISSN: 20479980 NLM ISO Abbreviation: J Am Heart Assoc Subsets: MEDLINE
    • Publication Information:
      Original Publication: Oxford : Wiley-Blackwell
    • Subject Terms:
      Antihypertensive Agents/*administration & dosage ; Blood Glucose/*metabolism ; Blood Pressure/*drug effects ; Cardiovascular Diseases/*epidemiology ; Diabetes Mellitus, Type 2/*mortality ; Fenofibrate/*administration & dosage ; Simvastatin/*administration & dosage; Aged ; Blood Glucose/drug effects ; Cardiovascular Diseases/blood ; Cardiovascular Diseases/complications ; Diabetes Mellitus, Type 2/blood ; Diabetes Mellitus, Type 2/drug therapy ; Dose-Response Relationship, Drug ; Drug Therapy, Combination ; Female ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage ; Hypolipidemic Agents ; Incidence ; Male ; Middle Aged ; Prognosis ; Risk Factors ; Survival Rate/trends ; Treatment Outcome ; United States/epidemiology
    • Abstract:
      Background Intensive systolic blood pressure ( SBP ) lowering significantly reduced cardiovascular disease ( CVD ) events in SPRINT (Systolic Blood Pressure Intervention Trial) but not in ACCORD BP (Action to Control Cardiovascular Risk in Diabetes Blood Pressure). Methods and Results SPRINT tested the effects of intensive (<120 mm Hg) versus standard (<140 mm Hg) SBP goals on CVD events and all-cause mortality. Using 2×2 factorial design, ACCORD BP tested the same SBP intervention in addition to an intensive versus standard glycemia intervention. We compared the effects of intensive SBP lowering on the composite CVD end point and all-cause mortality in SPRINT with its effects within each of the glycemia arms in ACCORD BP . Intensive SBP lowering decreased the hazard of the composite CVD end point similarly in SPRINT (hazard ratio: 0.75; 95% confidence interval, 0.64-0.89) and in the ACCORD BP standard glycemia arm (hazard ratio: 0.77; 95% confidence interval, 0.63-0.95; interaction P=0.87). However, the effect of intensive SBP lowering on the composite CVD end point in the ACCORD BP intensive glycemia arm (hazard ratio: 1.04; 95% confidence interval, 0.83-1.29) was significantly different from SPRINT (interaction P=0.023). Patterns were similar for all-cause mortality. Conclusions The effects of intensive SBP control on CVD events and all-cause mortality were similar in patients without diabetes mellitus and in those with diabetes mellitus on standard glycemic control. An interaction between intensive SBP lowering and intensive glycemic control may have masked beneficial effects of intensive SBP lowering in ACCORD BP . Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifiers: NCT 01206062, NCT 00000620.
    • Comments:
      Comment in: J Am Heart Assoc. 2018 Sep 18;7(18):e010508. (PMID: 30371207)
    • References:
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    • Grant Information:
      UL1 TR002538 United States TR NCATS NIH HHS; P30 DK079626 United States DK NIDDK NIH HHS; UL1 TR002003 United States TR NCATS NIH HHS; R01 DK091437 United States DK NIDDK NIH HHS; R21 DK106574 United States DK NIDDK NIH HHS
    • Contributed Indexing:
      Keywords: cardiovascular outcomes; diabetes mellitus; high blood pressure; hypertension
    • Accession Number:
      0 (Antihypertensive Agents)
      0 (Blood Glucose)
      0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors)
      0 (Hypolipidemic Agents)
      AGG2FN16EV (Simvastatin)
      U202363UOS (Fenofibrate)
    • Publication Date:
      Date Created: 20181030 Date Completed: 20191108 Latest Revision: 20220210
    • Publication Date:
      20240628
    • Accession Number:
      PMC6222943
    • Accession Number:
      10.1161/JAHA.118.009326
    • Accession Number:
      30371182