Effects of intensive blood-pressure control in type 2 diabetes mellitus

William Cushman, Gregory W. Evans, Robert P. Byington, David C. Goff, Richard H. Grimm, Jeffrey A. Cutler, Denise G. Simons-Morton, Jan N. Basile, Marshall A. Corson, Jeffrey L. Probstfield, Lois Katz, Kevin A. Peterson, William T. Friedewald, John B. Buse, J. Thomas Bigger, Hertzel C. Gerstein, Faramarz Ismail-Beigi

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Abstract

Background: There is no evidence from randomized trials to support a strategy of lowering systolic blood pressure below 135 to 140 mm Hg in persons with type 2 diabetes mellitus. We investigated whether therapy targeting normal systolic pressure (i.e., <120 mm Hg) reduces major cardiovascular events in participants with type 2 diabetes at high risk for cardiovascular events. Methods: A total of 4733 participants with type 2 diabetes were randomly assigned to intensive therapy, targeting a systolic pressure of less than 120 mm Hg, or standard therapy, targeting a systolic pressure of less than 140 mm Hg. The primary composite outcome was nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The mean follow-up was 4.7 years. Results: After 1 year, the mean systolic blood pressure was 119.3 mm Hg in the intensivetherapy group and 133.5 mm Hg in the standard-therapy group. The annual rate of the primary outcome was 1.87% in the intensive-therapy group and 2.09% in the standard-therapy group (hazard ratio with intensive therapy, 0.88; 95% confidence interval [CI], 0.73 to 1.06; P = 0.20). The annual rates of death from any cause were 1.28% and 1.19% in the two groups, respectively (hazard ratio, 1.07; 95% CI, 0.85 to 1.35; P = 0.55). The annual rates of stroke, a prespecified secondary outcome, were 0.32% and 0.53% in the two groups, respectively (hazard ratio, 0.59; 95% CI, 0.39 to 0.89; P = 0.01). Serious adverse events attributed to antihypertensive treatment occurred in 77 of the 2362 participants in the intensive-therapy group (3.3%) and 30 of the 2371 participants in the standard-therapy group (1.3%) (P<0.001). Conclusions: In patients with type 2 diabetes at high risk for cardiovascular events, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, did not reduce the rate of a composite outcome of fatal and nonfatal major cardiovascular events.

Original languageEnglish (US)
Pages (from-to)1575-1585
Number of pages11
JournalNew England Journal of Medicine
Volume362
Issue number17
DOIs
StatePublished - Apr 29 2010

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Type 2 Diabetes Mellitus
Blood Pressure
Group Psychotherapy
Confidence Intervals
Cause of Death
Stroke
Therapeutics
Fatal Outcome
Antihypertensive Agents
Myocardial Infarction
Mortality

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Cushman, W., Evans, G. W., Byington, R. P., Goff, D. C., Grimm, R. H., Cutler, J. A., ... Ismail-Beigi, F. (2010). Effects of intensive blood-pressure control in type 2 diabetes mellitus. New England Journal of Medicine, 362(17), 1575-1585. https://doi.org/10.1056/NEJMoa1001286

Effects of intensive blood-pressure control in type 2 diabetes mellitus. / Cushman, William; Evans, Gregory W.; Byington, Robert P.; Goff, David C.; Grimm, Richard H.; Cutler, Jeffrey A.; Simons-Morton, Denise G.; Basile, Jan N.; Corson, Marshall A.; Probstfield, Jeffrey L.; Katz, Lois; Peterson, Kevin A.; Friedewald, William T.; Buse, John B.; Bigger, J. Thomas; Gerstein, Hertzel C.; Ismail-Beigi, Faramarz.

In: New England Journal of Medicine, Vol. 362, No. 17, 29.04.2010, p. 1575-1585.

Research output: Contribution to journalArticle

Cushman, W, Evans, GW, Byington, RP, Goff, DC, Grimm, RH, Cutler, JA, Simons-Morton, DG, Basile, JN, Corson, MA, Probstfield, JL, Katz, L, Peterson, KA, Friedewald, WT, Buse, JB, Bigger, JT, Gerstein, HC & Ismail-Beigi, F 2010, 'Effects of intensive blood-pressure control in type 2 diabetes mellitus', New England Journal of Medicine, vol. 362, no. 17, pp. 1575-1585. https://doi.org/10.1056/NEJMoa1001286
Cushman, William ; Evans, Gregory W. ; Byington, Robert P. ; Goff, David C. ; Grimm, Richard H. ; Cutler, Jeffrey A. ; Simons-Morton, Denise G. ; Basile, Jan N. ; Corson, Marshall A. ; Probstfield, Jeffrey L. ; Katz, Lois ; Peterson, Kevin A. ; Friedewald, William T. ; Buse, John B. ; Bigger, J. Thomas ; Gerstein, Hertzel C. ; Ismail-Beigi, Faramarz. / Effects of intensive blood-pressure control in type 2 diabetes mellitus. In: New England Journal of Medicine. 2010 ; Vol. 362, No. 17. pp. 1575-1585.
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abstract = "Background: There is no evidence from randomized trials to support a strategy of lowering systolic blood pressure below 135 to 140 mm Hg in persons with type 2 diabetes mellitus. We investigated whether therapy targeting normal systolic pressure (i.e., <120 mm Hg) reduces major cardiovascular events in participants with type 2 diabetes at high risk for cardiovascular events. Methods: A total of 4733 participants with type 2 diabetes were randomly assigned to intensive therapy, targeting a systolic pressure of less than 120 mm Hg, or standard therapy, targeting a systolic pressure of less than 140 mm Hg. The primary composite outcome was nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The mean follow-up was 4.7 years. Results: After 1 year, the mean systolic blood pressure was 119.3 mm Hg in the intensivetherapy group and 133.5 mm Hg in the standard-therapy group. The annual rate of the primary outcome was 1.87{\%} in the intensive-therapy group and 2.09{\%} in the standard-therapy group (hazard ratio with intensive therapy, 0.88; 95{\%} confidence interval [CI], 0.73 to 1.06; P = 0.20). The annual rates of death from any cause were 1.28{\%} and 1.19{\%} in the two groups, respectively (hazard ratio, 1.07; 95{\%} CI, 0.85 to 1.35; P = 0.55). The annual rates of stroke, a prespecified secondary outcome, were 0.32{\%} and 0.53{\%} in the two groups, respectively (hazard ratio, 0.59; 95{\%} CI, 0.39 to 0.89; P = 0.01). Serious adverse events attributed to antihypertensive treatment occurred in 77 of the 2362 participants in the intensive-therapy group (3.3{\%}) and 30 of the 2371 participants in the standard-therapy group (1.3{\%}) (P<0.001). Conclusions: In patients with type 2 diabetes at high risk for cardiovascular events, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, did not reduce the rate of a composite outcome of fatal and nonfatal major cardiovascular events.",
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AU - Cushman, William

AU - Evans, Gregory W.

AU - Byington, Robert P.

AU - Goff, David C.

AU - Grimm, Richard H.

AU - Cutler, Jeffrey A.

AU - Simons-Morton, Denise G.

AU - Basile, Jan N.

AU - Corson, Marshall A.

AU - Probstfield, Jeffrey L.

AU - Katz, Lois

AU - Peterson, Kevin A.

AU - Friedewald, William T.

AU - Buse, John B.

AU - Bigger, J. Thomas

AU - Gerstein, Hertzel C.

AU - Ismail-Beigi, Faramarz

PY - 2010/4/29

Y1 - 2010/4/29

N2 - Background: There is no evidence from randomized trials to support a strategy of lowering systolic blood pressure below 135 to 140 mm Hg in persons with type 2 diabetes mellitus. We investigated whether therapy targeting normal systolic pressure (i.e., <120 mm Hg) reduces major cardiovascular events in participants with type 2 diabetes at high risk for cardiovascular events. Methods: A total of 4733 participants with type 2 diabetes were randomly assigned to intensive therapy, targeting a systolic pressure of less than 120 mm Hg, or standard therapy, targeting a systolic pressure of less than 140 mm Hg. The primary composite outcome was nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The mean follow-up was 4.7 years. Results: After 1 year, the mean systolic blood pressure was 119.3 mm Hg in the intensivetherapy group and 133.5 mm Hg in the standard-therapy group. The annual rate of the primary outcome was 1.87% in the intensive-therapy group and 2.09% in the standard-therapy group (hazard ratio with intensive therapy, 0.88; 95% confidence interval [CI], 0.73 to 1.06; P = 0.20). The annual rates of death from any cause were 1.28% and 1.19% in the two groups, respectively (hazard ratio, 1.07; 95% CI, 0.85 to 1.35; P = 0.55). The annual rates of stroke, a prespecified secondary outcome, were 0.32% and 0.53% in the two groups, respectively (hazard ratio, 0.59; 95% CI, 0.39 to 0.89; P = 0.01). Serious adverse events attributed to antihypertensive treatment occurred in 77 of the 2362 participants in the intensive-therapy group (3.3%) and 30 of the 2371 participants in the standard-therapy group (1.3%) (P<0.001). Conclusions: In patients with type 2 diabetes at high risk for cardiovascular events, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, did not reduce the rate of a composite outcome of fatal and nonfatal major cardiovascular events.

AB - Background: There is no evidence from randomized trials to support a strategy of lowering systolic blood pressure below 135 to 140 mm Hg in persons with type 2 diabetes mellitus. We investigated whether therapy targeting normal systolic pressure (i.e., <120 mm Hg) reduces major cardiovascular events in participants with type 2 diabetes at high risk for cardiovascular events. Methods: A total of 4733 participants with type 2 diabetes were randomly assigned to intensive therapy, targeting a systolic pressure of less than 120 mm Hg, or standard therapy, targeting a systolic pressure of less than 140 mm Hg. The primary composite outcome was nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The mean follow-up was 4.7 years. Results: After 1 year, the mean systolic blood pressure was 119.3 mm Hg in the intensivetherapy group and 133.5 mm Hg in the standard-therapy group. The annual rate of the primary outcome was 1.87% in the intensive-therapy group and 2.09% in the standard-therapy group (hazard ratio with intensive therapy, 0.88; 95% confidence interval [CI], 0.73 to 1.06; P = 0.20). The annual rates of death from any cause were 1.28% and 1.19% in the two groups, respectively (hazard ratio, 1.07; 95% CI, 0.85 to 1.35; P = 0.55). The annual rates of stroke, a prespecified secondary outcome, were 0.32% and 0.53% in the two groups, respectively (hazard ratio, 0.59; 95% CI, 0.39 to 0.89; P = 0.01). Serious adverse events attributed to antihypertensive treatment occurred in 77 of the 2362 participants in the intensive-therapy group (3.3%) and 30 of the 2371 participants in the standard-therapy group (1.3%) (P<0.001). Conclusions: In patients with type 2 diabetes at high risk for cardiovascular events, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, did not reduce the rate of a composite outcome of fatal and nonfatal major cardiovascular events.

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