Systolic blood pressure control among individuals with type 2 diabetes

A comparative effectiveness analysis of three interventions

Look AHEAD Research Group, ACCORD Study Group

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

BACKGROUND The relative effectiveness of 3 approaches to blood pressure control- (i) an intensive lifestyle intervention (ILI) focused on weight loss, (ii) frequent goal-based monitoring of blood pressure with pharmacological management, and (iii) education and support-has not been established among overweight and obese adults with type 2 diabetes who are appropriate for each intervention. METHODS Participants from the Action for Health in Diabetes (Look AHEAD) and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) cohorts who met criteria for both clinical trials were identified. The proportions of these individuals with systolic blood pressure (SBP) <140 mm Hg from annual standardized assessments over time were compared with generalized estimating equations. RESULTS Across 4 years among 480 Look AHEAD and 1,129 ACCORD participants with baseline SBPs between 130 and 159 mm Hg, ILI (OR = 1.46; 95% CI = [1.18-1.81]) and frequent goal-based monitoring with pharmacotherapy (OR = 1.51; 95% CI = [1.16-1.97]) yielded higher rates of blood pressure control compared to education and support. The intensive behavioral-based intervention may have been more effective among individuals with body mass index >30 kg/m2, while frequent goal-based monitoring with medication management may be more effective among individuals with lower body mass index (interaction P = 0.047). CONCLUSIONS Among overweight and obese adults with type 2 diabetes, both ILI and frequent goal-based monitoring with pharmacological management can be successful strategies for blood pressure control. clinical trials registry clinicaltrials.gov identifiers NCT00017953 (Look AHEAD) and NCT00000620 (ACCORD).

Original languageEnglish (US)
Pages (from-to)995-1009
Number of pages15
JournalAmerican journal of hypertension
Volume28
Issue number8
DOIs
StatePublished - May 11 2015

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Type 2 Diabetes Mellitus
Blood Pressure
Life Style
Clinical Trials
Pharmacology
Registries
Weight Loss
Body Mass Index
Education
Health

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Systolic blood pressure control among individuals with type 2 diabetes : A comparative effectiveness analysis of three interventions. / Look AHEAD Research Group; ACCORD Study Group.

In: American journal of hypertension, Vol. 28, No. 8, 11.05.2015, p. 995-1009.

Research output: Contribution to journalArticle

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title = "Systolic blood pressure control among individuals with type 2 diabetes: A comparative effectiveness analysis of three interventions",
abstract = "BACKGROUND The relative effectiveness of 3 approaches to blood pressure control- (i) an intensive lifestyle intervention (ILI) focused on weight loss, (ii) frequent goal-based monitoring of blood pressure with pharmacological management, and (iii) education and support-has not been established among overweight and obese adults with type 2 diabetes who are appropriate for each intervention. METHODS Participants from the Action for Health in Diabetes (Look AHEAD) and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) cohorts who met criteria for both clinical trials were identified. The proportions of these individuals with systolic blood pressure (SBP) <140 mm Hg from annual standardized assessments over time were compared with generalized estimating equations. RESULTS Across 4 years among 480 Look AHEAD and 1,129 ACCORD participants with baseline SBPs between 130 and 159 mm Hg, ILI (OR = 1.46; 95{\%} CI = [1.18-1.81]) and frequent goal-based monitoring with pharmacotherapy (OR = 1.51; 95{\%} CI = [1.16-1.97]) yielded higher rates of blood pressure control compared to education and support. The intensive behavioral-based intervention may have been more effective among individuals with body mass index >30 kg/m2, while frequent goal-based monitoring with medication management may be more effective among individuals with lower body mass index (interaction P = 0.047). CONCLUSIONS Among overweight and obese adults with type 2 diabetes, both ILI and frequent goal-based monitoring with pharmacological management can be successful strategies for blood pressure control. clinical trials registry clinicaltrials.gov identifiers NCT00017953 (Look AHEAD) and NCT00000620 (ACCORD).",
author = "{Look AHEAD Research Group} and {ACCORD Study Group} and Espeland, {Mark A.} and Jeffery Probstfield and Donald Hire and Redmon, {J. Bruce} and Evans, {Gregory W.} and Mace Coday and Lewis, {Cora E.} and Johnson, {Karen C.} and Sharon Wilmoth and Judy Bahnson and Dulin, {Michael F.} and Green, {Jennifer B.} and Knowler, {William C.} and Abbas Kitabchi and Murillo, {Anne L.} and Kwame Osei and Rehman, {Shakaib U.} and Brancati, {Frederick L.} and Lee Swartz and Mathilda Coday and Clark, {Jeanne M.} and Karen Johnson and Richard Rubin and Jean Arceci and Suzanne Ball and Jeanne Charleston and Danielle Diggins and Mia Johnson and Joyce Lambert and Kathy Michalski and Dawn Jiggetts and Chanchai Sapun and Bray, {George A.} and Kristi Rau and Allison Strate and Greenway, {Frank L.} and Ryan, {Donna H.} and Donald Williamson and Brandi Armand and Jennifer Arceneaux and Amy Bachand and Michelle Begnaud and Betsy Berhard and Elizabeth Caderette and Barbara Cerniauskas and David Creel and Diane Crow and Ebenezer Nyenwe and William Cushman and Marshall Elam",
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T2 - A comparative effectiveness analysis of three interventions

AU - Look AHEAD Research Group

AU - ACCORD Study Group

AU - Espeland, Mark A.

AU - Probstfield, Jeffery

AU - Hire, Donald

AU - Redmon, J. Bruce

AU - Evans, Gregory W.

AU - Coday, Mace

AU - Lewis, Cora E.

AU - Johnson, Karen C.

AU - Wilmoth, Sharon

AU - Bahnson, Judy

AU - Dulin, Michael F.

AU - Green, Jennifer B.

AU - Knowler, William C.

AU - Kitabchi, Abbas

AU - Murillo, Anne L.

AU - Osei, Kwame

AU - Rehman, Shakaib U.

AU - Brancati, Frederick L.

AU - Swartz, Lee

AU - Coday, Mathilda

AU - Clark, Jeanne M.

AU - Johnson, Karen

AU - Rubin, Richard

AU - Arceci, Jean

AU - Ball, Suzanne

AU - Charleston, Jeanne

AU - Diggins, Danielle

AU - Johnson, Mia

AU - Lambert, Joyce

AU - Michalski, Kathy

AU - Jiggetts, Dawn

AU - Sapun, Chanchai

AU - Bray, George A.

AU - Rau, Kristi

AU - Strate, Allison

AU - Greenway, Frank L.

AU - Ryan, Donna H.

AU - Williamson, Donald

AU - Armand, Brandi

AU - Arceneaux, Jennifer

AU - Bachand, Amy

AU - Begnaud, Michelle

AU - Berhard, Betsy

AU - Caderette, Elizabeth

AU - Cerniauskas, Barbara

AU - Creel, David

AU - Crow, Diane

AU - Nyenwe, Ebenezer

AU - Cushman, William

AU - Elam, Marshall

PY - 2015/5/11

Y1 - 2015/5/11

N2 - BACKGROUND The relative effectiveness of 3 approaches to blood pressure control- (i) an intensive lifestyle intervention (ILI) focused on weight loss, (ii) frequent goal-based monitoring of blood pressure with pharmacological management, and (iii) education and support-has not been established among overweight and obese adults with type 2 diabetes who are appropriate for each intervention. METHODS Participants from the Action for Health in Diabetes (Look AHEAD) and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) cohorts who met criteria for both clinical trials were identified. The proportions of these individuals with systolic blood pressure (SBP) <140 mm Hg from annual standardized assessments over time were compared with generalized estimating equations. RESULTS Across 4 years among 480 Look AHEAD and 1,129 ACCORD participants with baseline SBPs between 130 and 159 mm Hg, ILI (OR = 1.46; 95% CI = [1.18-1.81]) and frequent goal-based monitoring with pharmacotherapy (OR = 1.51; 95% CI = [1.16-1.97]) yielded higher rates of blood pressure control compared to education and support. The intensive behavioral-based intervention may have been more effective among individuals with body mass index >30 kg/m2, while frequent goal-based monitoring with medication management may be more effective among individuals with lower body mass index (interaction P = 0.047). CONCLUSIONS Among overweight and obese adults with type 2 diabetes, both ILI and frequent goal-based monitoring with pharmacological management can be successful strategies for blood pressure control. clinical trials registry clinicaltrials.gov identifiers NCT00017953 (Look AHEAD) and NCT00000620 (ACCORD).

AB - BACKGROUND The relative effectiveness of 3 approaches to blood pressure control- (i) an intensive lifestyle intervention (ILI) focused on weight loss, (ii) frequent goal-based monitoring of blood pressure with pharmacological management, and (iii) education and support-has not been established among overweight and obese adults with type 2 diabetes who are appropriate for each intervention. METHODS Participants from the Action for Health in Diabetes (Look AHEAD) and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) cohorts who met criteria for both clinical trials were identified. The proportions of these individuals with systolic blood pressure (SBP) <140 mm Hg from annual standardized assessments over time were compared with generalized estimating equations. RESULTS Across 4 years among 480 Look AHEAD and 1,129 ACCORD participants with baseline SBPs between 130 and 159 mm Hg, ILI (OR = 1.46; 95% CI = [1.18-1.81]) and frequent goal-based monitoring with pharmacotherapy (OR = 1.51; 95% CI = [1.16-1.97]) yielded higher rates of blood pressure control compared to education and support. The intensive behavioral-based intervention may have been more effective among individuals with body mass index >30 kg/m2, while frequent goal-based monitoring with medication management may be more effective among individuals with lower body mass index (interaction P = 0.047). CONCLUSIONS Among overweight and obese adults with type 2 diabetes, both ILI and frequent goal-based monitoring with pharmacological management can be successful strategies for blood pressure control. clinical trials registry clinicaltrials.gov identifiers NCT00017953 (Look AHEAD) and NCT00000620 (ACCORD).

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U2 - 10.1093/ajh/hpu292

DO - 10.1093/ajh/hpu292

M3 - Article

VL - 28

SP - 995

EP - 1009

JO - American Journal of Hypertension

JF - American Journal of Hypertension

SN - 0895-7061

IS - 8

ER -