Intensive BP control improved outcomes in patients with type 2 diabetes, trial finds
A composite of nonfatal stroke, nonfatal myocardial infarction, treatment or hospitalization for heart failure, or death from cardiovascular causes was significantly lower among patients treated to a blood pressure (BP) target of less than 120 mm Hg versus one below 140 mm Hg.
Incidence of major cardiovascular events among patients with type 2 diabetes was significantly lower with intensive treatment targeting a systolic blood pressure (SBP) below 120 mm Hg than with standard treatment targeting an SBP below 140 mm Hg, a Chinese trial found.
Researchers enrolled patients 50 years of age or older with type 2 diabetes, elevated SBP, and an increased risk of cardiovascular disease at 145 clinical sites across China. Patients were randomized to receive intensive treatment that targeted a SBP below 120 mm Hg or standard treatment that targeted a SBP below 140 mm Hg for as long as five years.
Overall, 12,821 patients (6,414 patients in the intensive treatment group and 6,407 in the standard treatment group) were enrolled in the study from February 2019 through December 2021 (45.3% women; mean age, 63.8 years). The primary outcome was a composite of nonfatal stroke, nonfatal myocardial infarction, treatment or hospitalization for heart failure, or death from cardiovascular causes. Results were published by the New England Journal of Medicine on Nov. 16.
At one year of follow-up, mean SBP was 121.6 mm Hg (median, 118.3 mm Hg) in the intensive treatment group and 133.2 mm Hg (median, 135.0 mm Hg) in the standard treatment group. The primary outcome occurred in 393 patients (1.65 events per 100 person-years) in the intensive treatment group and 492 patients (2.09 events per 100 person-years) in the standard treatment group (hazard ratio, 0.79 [95% CI, 0.69 to 0.90]; P<0.001) over a median follow-up of 4.2 years. Rates of serious adverse events were similar in both groups, but symptomatic hypotension and hyperkalemia occurred more frequently in the intensive treatment group.
The study provided convincing evidence of the benefits of lowering SBP to a target of less than 120 mm Hg in patients with type 2 diabetes, consistent with the SPRINT and ESPRIT results, the study authors wrote.
“Our trial has important implications for blood-pressure management in clinical practice,” they wrote. “Although the Eighth Joint National Committee recommended a systolic blood pressure of less than 140 mm Hg in patients with type 2 diabetes on the basis of findings from the ACCORD trial, most current guidelines recommend a systolic blood pressure of less than 130 mm Hg in patients with diabetes. … Our results with respect to the primary outcome provide support for more-intensive systolic blood-pressure control in patients with diabetes for the prevention of major cardiovascular disease events.”
They added the caveat that patients trying to achieve intensive blood pressure targets need to be monitored for hypotension, especially during the start of treatment, and hyperkalemia if multiple antihypertensive drugs are used.