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

Cardiology

Journal of Hypertension: Open Access

Author(s): ACCORD Study Group, Cushman WC, Evans GW, Byington RP, Goff DC Jr,

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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 intensive-therapy 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. (ClinicalTrials.gov number, NCT00000620.) 2010 Massachusetts Medical Society
This article was published in N Engl J Med and referenced in Journal of Hypertension: Open Access

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