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

Srinivasan Beddhu, Glenn M. Chertow, Tom Greene, Paul K. Whelton, Walter T. Ambrosius, Alfred K. Cheung, Jeffrey Cutler, Lawrence Fine, Robert Boucher, Guo Wei, Chong Zhang, Holly Kramer, Adam P. Bress, Paul L. Kimmel, Suzanne Oparil, Cora E. Lewis, Mahboob Rahman, William Cushman

Research output: Contribution to journalArticle

3 Citations (Scopus)

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 292 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.

Original languageEnglish (US)
Article numbere009326
JournalJournal of the American Heart Association
Volume7
Issue number18
DOIs
StatePublished - Sep 1 2018

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Type 2 Diabetes Mellitus
Diabetes Mellitus
Blood Pressure
Mortality
Cardiovascular Diseases
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

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. / Beddhu, Srinivasan; Chertow, Glenn M.; Greene, Tom; Whelton, Paul K.; Ambrosius, Walter T.; Cheung, Alfred K.; Cutler, Jeffrey; Fine, Lawrence; Boucher, Robert; Wei, Guo; Zhang, Chong; Kramer, Holly; Bress, Adam P.; Kimmel, Paul L.; Oparil, Suzanne; Lewis, Cora E.; Rahman, Mahboob; Cushman, William.

In: Journal of the American Heart Association, Vol. 7, No. 18, e009326, 01.09.2018.

Research output: Contribution to journalArticle

Beddhu, S, Chertow, GM, Greene, T, Whelton, PK, Ambrosius, WT, Cheung, AK, Cutler, J, Fine, L, Boucher, R, Wei, G, Zhang, C, Kramer, H, Bress, AP, Kimmel, PL, Oparil, S, Lewis, CE, Rahman, M & Cushman, W 2018, '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', Journal of the American Heart Association, vol. 7, no. 18, e009326. https://doi.org/10.1161/JAHA.118.009326
Beddhu, Srinivasan ; Chertow, Glenn M. ; Greene, Tom ; Whelton, Paul K. ; Ambrosius, Walter T. ; Cheung, Alfred K. ; Cutler, Jeffrey ; Fine, Lawrence ; Boucher, Robert ; Wei, Guo ; Zhang, Chong ; Kramer, Holly ; Bress, Adam P. ; Kimmel, Paul L. ; Oparil, Suzanne ; Lewis, Cora E. ; Rahman, Mahboob ; Cushman, William. / 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. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 18.
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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 292 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.",
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T1 - 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

T2 - Reconciling results from ACCORD BP and SPRINT

AU - Beddhu, Srinivasan

AU - Chertow, Glenn M.

AU - Greene, Tom

AU - Whelton, Paul K.

AU - Ambrosius, Walter T.

AU - Cheung, Alfred K.

AU - Cutler, Jeffrey

AU - Fine, Lawrence

AU - Boucher, Robert

AU - Wei, Guo

AU - Zhang, Chong

AU - Kramer, Holly

AU - Bress, Adam P.

AU - Kimmel, Paul L.

AU - Oparil, Suzanne

AU - Lewis, Cora E.

AU - Rahman, Mahboob

AU - Cushman, William

PY - 2018/9/1

Y1 - 2018/9/1

N2 - 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 292 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.

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