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Abstract: SA-OR054

Influence of Intensive Glycemia Intervention on the Effects of Intensive Systolic Blood Pressure (SBP) Lowering in Type 2 Diabetes Mellitus: Reconciling Results from ACCORD BP and SPRINT

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Beddhu, Srinivasan, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Greene, Tom, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Cheung, Alfred K., University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Chertow, Glenn Matthew, Stanford University School of Medicine, Palo Alto, California, United States
  • Kramer, Holly J., Loyola University Medical Center, Maywood, Illinois, United States
  • Kimmel, Paul L., National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States
  • Boucher, Robert E., University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Fine, Lawrence J., NHLBI, Washington, District of Columbia, United States
  • Wei, Guo, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Zhang, Chong, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Rahman, Mahboob, Case Western Reserve University , Cleveland, Ohio, United States
  • Oparil, Suzanne, University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Ambrosius, Walter T., Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
  • Bress, Adam, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Cutler, Jeffrey A., NHLBI, Washington, District of Columbia, United States
  • Whelton, Paul K., Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Cushman, William C., Memphis VA Medical Center, Memphis, Tennessee, United States
Background

Intensive systolic blood pressure (SBP) lowering significantly reduced cardiovascular disease (CVD) events in the Systolic Blood Pressure Intervention Trial (SPRINT) but not in the Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial (ACCORD BP).

Methods

SPRINT ( N =9361) tested the effects of intensive (<120 mm Hg) versus standard (<140 mm Hg) SBP goals on CVD events and all-cause mortality. Using 2x2 factorial design, ACCORD BP (N = 4733) tested the same SBP intervention in addition to an intensive versus standard glycemia intervention. We compared the effects of intensive SBP lowering on the composite CVD endpoint and all-cause mortality in SPRINT with its effects within each of the glycemia arms in ACCORD BP.

Results

As shown in the figure, intensive SBP lowering decreased the hazard of the composite CVD endpoint similarly in SPRINT and the ACCORD BP standard glycemia arm (interaction p=0.87). However, the effect of intensive SBP lowering on the composite CVD endpoint in the ACCORD BP intensive glycemia arm was significantly different from SPRINT. Patterns were similar for all-cause mortality.

Conclusion

The effects of intensive SBP control on CVD events and all-cause mortality were similar in persons without diabetes and in persons with diabetes on standard glycemic control. An interaction between intensive SBP lowering and intensive glycemic control may have masked beneficial effects of intensive SBP lowering in ACCORD BP.

Hazard ratios for CVD events and ACM for intensive vs. standard SBP goals in SPRINT and ACCORD BP glycemia arms

Funding

  • NIDDK Support