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Intensive BP treatment cardioprotective in T2DM patients receiving standard glycaemic control

07 Aug 2018

Intensive blood pressure (BP) treatment yields a significant reduction in the risk of cardiovascular events, including heart failure, in patients with type 2 diabetes mellitus (T2DM) receiving standard but not intensive glycaemic control therapy, as shown in a recent study.

The present analysis included T2DM patients (mean age 62.8 years; 48 percent female) enrolled in the ACCORD BP trial (Action to Control Cardiovascular Risk in Diabetes Blood Pressure). There were 2,362 patients receiving standard glucose-lowering therapy (standard BP treatment, n=1,178; intensive BP, n=1,184) and 2,371 on intensive glycaemic control treatment (standard BP, n=1,193; intensive BP, n=1,178).

During a mean follow-up of 4.5 years, the primary outcome of a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke and hospitalized congestive heart failure occurred in 528 patients overall. In the standard glycaemic control group, the risk of a cardiovascular event was significantly lower among patients receiving intensive vs standard BP therapy (hazard ratio [HR], 0.71; 95 percent CI, 0.56–0.90; p=0.005). In the intensive glycaemic control group, on the other hand, the risk did not significantly differ between the two BP treatment subgroups (HR, 1.06; 0.83–1.36; p=0.61).

Similar results were found for stroke risk, which was markedly lower among patients in the standard glycaemic control group receiving intensive BP treatment. Such risk reduction was absent in the intensive glycaemic control group.

A nonsignificant increase in all-cause mortality risk was seen among patients in the intensive glycaemic control group receiving intensive vs standard BP treatment (HR, 1.38; 0.99–1.92; p=0.05).

Researchers pointed out that the benefits of intensive BP treatment were observed only in ACCORD BP patients receiving standard glycaemic control without additional risk factors. Additional studies are warranted to confirm the safety and efficacy of intensive BP treatment in high-risk patients with T2DM.

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