PMID- 29212825
OWN - NLM
STAT- MEDLINE
DCOM- 20180828
LR  - 20181202
IS  - 1935-5548 (Electronic)
IS  - 0149-5992 (Linking)
VI  - 41
IP  - 6
DP  - 2018 Jun
TI  - Intensive Blood Pressure Lowering in Patients With and Patients Without Type 2 
      Diabetes: A Pooled Analysis From Two Randomized Trials.
PG  - 1142-1148
LID - 10.2337/dc17-1722 [doi]
AB  - OBJECTIVE: The Action to Control Cardiovascular Risk in Diabetes Blood Pressure 
      (ACCORD-BP) study did not find a significant beneficial effect of intensive 
      systolic blood pressure (SBP) lowering on cardiovascular events in hypertensive 
      patients with type 2 diabetes mellitus (T2DM), while the Systolic Blood Pressure 
      Intervention Trial (SPRINT) did find a significant beneficial effect in patients 
      without T2DM. The objective of this analysis was to assess the effect of both 
      T2DM and baseline cardiovascular disease risk on the treatment effect of 
      intensive blood pressure lowering. RESEARCH DESIGN AND METHODS: The individual 
      patient data from the ACCORD-BP and SPRINT studies were pooled and follow-up 
      durations harmonized. Both studies randomized hypertensive patients to an SBP 
      target of <120 mmHg or a target of <140 mmHg. The composite primary end point 
      consisted of unstable angina, myocardial infarction, acute heart failure, stroke, 
      and cardiovascular death. The interaction between intensive blood pressure 
      lowering and both T2DM and 10-year cardiovascular risk was assessed using Cox 
      proportional hazards models. RESULTS: The cohort consisted of 14,094 patients 
      with mean age 66 +/- 8.9 years and mean baseline SBP 139.5 +/- 15.6 mmHg; 33.6% had 
      T2DM. The hazard ratio for the primary composite end point was 0.82 (95% CI 
      0.73-0.93), P = 0.0017. The interaction between intensive blood pressure lowering 
      and T2DM was nonsignificant (P = 0.13). The 10-year cardiovascular risk was 
      higher in primary prevention patients with T2DM, but risk did not interact with 
      the treatment effect (P = 0.84). CONCLUSIONS: Intensive blood pressure lowering 
      may have a similar favorable effect and appears to decrease cardiovascular events 
      in both patients with and patients without T2DM.
CI  - (c) 2018 by the American Diabetes Association.
FAU - Brouwer, Tom F
AU  - Brouwer TF
AUID- ORCID: 0000-0001-8379-7470
AD  - Heart Center, Department of Clinical and Experimental Cardiology, Academic 
      Medical Center, University of Amsterdam, Amsterdam, the Netherlands 
      t.f.brouwer@amc.uva.nl.
FAU - Vehmeijer, Jim T
AU  - Vehmeijer JT
AD  - Heart Center, Department of Clinical and Experimental Cardiology, Academic 
      Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
FAU - Kalkman, Deborah N
AU  - Kalkman DN
AD  - Heart Center, Department of Clinical and Experimental Cardiology, Academic 
      Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
FAU - Berger, Wouter R
AU  - Berger WR
AD  - Heart Center, Department of Clinical and Experimental Cardiology, Academic 
      Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
AD  - Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
FAU - van den Born, Bert-Jan H
AU  - van den Born BH
AD  - Department of Internal and Vascular Medicine, Academic Medical Center, University 
      of Amsterdam, Amsterdam, the Netherlands.
FAU - Peters, Ron J
AU  - Peters RJ
AD  - Heart Center, Department of Clinical and Experimental Cardiology, Academic 
      Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
FAU - Knops, Reinoud E
AU  - Knops RE
AD  - Heart Center, Department of Clinical and Experimental Cardiology, Academic 
      Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
LA  - eng
SI  - ClinicalTrials.gov/NCT01206062
SI  - ClinicalTrials.gov/NCT00000620
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20171206
PL  - United States
TA  - Diabetes Care
JT  - Diabetes care
JID - 7805975
RN  - 0 (Antihypertensive Agents)
SB  - IM
MH  - Aged
MH  - Antihypertensive Agents/*therapeutic use
MH  - Blood Pressure/drug effects/physiology
MH  - Cohort Studies
MH  - Diabetes Mellitus, Type 2/complications/*drug 
      therapy/epidemiology/physiopathology
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/epidemiology/prevention & control
MH  - Humans
MH  - Hypertension/complications/*drug therapy/epidemiology/physiopathology
MH  - Male
MH  - Middle Aged
MH  - Multicenter Studies as Topic/statistics & numerical data
MH  - Myocardial Infarction/epidemiology/prevention & control
MH  - Randomized Controlled Trials as Topic/*statistics & numerical data
MH  - Stroke/epidemiology/prevention & control
MH  - Systole
MH  - Treatment Outcome
EDAT- 2017/12/08 06:00
MHDA- 2018/08/29 06:00
CRDT- 2017/12/08 06:00
PHST- 2017/08/17 00:00 [received]
PHST- 2017/11/10 00:00 [accepted]
PHST- 2017/12/08 06:00 [pubmed]
PHST- 2018/08/29 06:00 [medline]
PHST- 2017/12/08 06:00 [entrez]
AID - dc17-1722 [pii]
AID - 10.2337/dc17-1722 [doi]
PST - ppublish
SO  - Diabetes Care. 2018 Jun;41(6):1142-1148. doi: 10.2337/dc17-1722. Epub 2017 Dec 6.