Target blood pressure of less than 120 vs 140 mm Hg in DM2

January 01, 0001

Target blood pressure of less than 120 vs 140 mm Hg in DM2

These US authors investigated whether therapy targeting normal systolic pressure (i.e., less than 120 mm Hg) reduces major cardiovascular events in participants with type 2 diabetes at high risk for cardiovascular events. 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.

They found: "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 (NS). The annual rates of death from any cause were 1.28% and 1.19% in the two groups, respectively (hazard ratio, 1.07, NS). The annual rates of stroke, a prespecified secondary outcome, were 0.32% and 0.53% in the two groups, respectively (hazard ratio, 0.59, significant). 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%) (significant)."

The authors concluded: "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."

Expert opinion guidelines to target blood pressure in diabetic patients to below 140 mm Hg should be revised.

For the full abstract, click here.

N Engl J Med 362(17):1575-1585, 29 April 2010 © 2010 to the Massachusetts Medical Society
Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus-The ACCORD Study Group. William C. Cushman, Gregory W. Evans, Robert P. Byington, et al. Correspondence to Dr. Cushman: [email protected]

Category: K. Circulatory, T. Endocrine/Metabolic/Nutritional. Keywords: blood pressure, type 2 diabetes, intensive therapy, cardiovascular events, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 18 May 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.