Louise Moist, MD
In adults with type 2 diabetes mellitus, does intensive blood pressure (BP) control improve clinical outcomes more than standard BP control?
Included studies compared antihypertensive therapies to achieve prespecified BP targets in adults who had type 2 diabetes, and assessed ≥ 1 of mortality, myocardial infarction (MI), or stroke. Studies that assessed multifactorial interventions in which the effect of BP lowering could not be separated from the effects of other treatments were excluded. Outcomes were mortality, MI, stroke, and adverse events.
MEDLINE, EMBASE/Excerpta Medica, and Cochrane Central Register of Controlled Trials (all to Mar 2011); reference lists of identified trials and review articles; and clinicaltrials.gov and isrctn.org were searched for randomized or quasi-randomized controlled trials. Authors of published studies were contacted. 5 randomized controlled trials (RCTs) (n = 7313, mean age 53 to 62 y) with follow-up ranging from 2 to 5 years met the selection criteria. The intensive BP targets were diastolic BP (DBP) ≤ 75 mm Hg in 2 trials, DBP < 75 mm Hg in 1 trial, DBP ≤ 80 mm Hg in 1 trial, and systolic BP (SBP) < 120 mm Hg in 1 trial. Standard BP targets were DBP < 90 mm Hg in 2 trials, SBP < 140 mm Hg in 1 trial, SBP/DBP < 140/90 mm Hg in 1 trial, and 1 trial had 2 standard BP groups of DBP ≤ 85 mm Hg and ≤ 90 mm Hg. Trial size ranged from 129 to 4733 patients.
Meta-analysis showed that intensive BP targets reduced stroke but not mortality or MI (Table). Only 1 trial (ACCORD-BP, n = 4733) reported details of adverse events; the intensive BP target group had higher rates of serious adverse events than the standard BP target group (3.3% vs 1.7%, P < 0.001).
Intensive blood pressure control reduced stroke, but not myocardial infarction or mortality, compared with standard control in adults with type 2 diabetes.
Intensive vs standard blood pressure (BP) targets in adults with type 2 diabetes*
*Abbreviations defined in Glossary. Weighted intensive BP target event rate, RRR, NNT, and CI calculated from control event rates and risk ratios in article using a random-effects model.
†To avoid double-counting the intensive BP target group in the HOT study, the meta-analyses presented in this abstract exclude the HOT diastolic ≤ 80 mm Hg vs ≤ 85 mm Hg comparison; the results are slightly different quantitatively compared with the source article, but the overall conclusions are unchanged.
Moist L. Review: Intensive blood pressure control reduces stroke, but not mortality or MI, in type 2 diabetes. Ann Intern Med. ;158:JC5. doi: 10.7326/0003-4819-158-2-201301150-02005
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Published: Ann Intern Med. 2013;158(2):JC5.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Hypertension.
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