Kidney Week

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

• Hypertension and CVD: Epidemiology and Outcomes
  October 27, 2018 | Location: 6F, San Diego Convention Center
  Abstract Time: 05:42 PM - 05:54 PM

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

Srinivasan Beddhu, MD

• Greene, Tom, University of Utah School of Medicine, Salt Lake City, Utah, United States

Tom Greene,

• Cheung, Alfred K., University of Utah School of Medicine, Salt Lake City, Utah, United States

Alfred K. Cheung,

• Chertow, Glenn Matthew, Stanford University School of Medicine, Palo Alto, California, United States

Glenn Matthew Chertow,

• Kramer, Holly J., Loyola University Medical Center, Maywood, Illinois, United States

Holly J. Kramer,

• Kimmel, Paul L., National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States

Paul L. Kimmel,

• Boucher, Robert E., University of Utah School of Medicine, Salt Lake City, Utah, United States

Robert E. Boucher,

• Fine, Lawrence J., NHLBI, Washington, District of Columbia, United States

Lawrence J. Fine,

• Wei, Guo, University of Utah School of Medicine, Salt Lake City, Utah, United States

Guo Wei,

• Zhang, Chong, University of Utah School of Medicine, Salt Lake City, Utah, United States

Chong Zhang,

• Rahman, Mahboob, Case Western Reserve University , Cleveland, Ohio, United States

Mahboob Rahman,

• Oparil, Suzanne, University of Alabama at Birmingham, Birmingham, Alabama, United States

Suzanne Oparil,

• Ambrosius, Walter T., Wake Forest School of Medicine, Winston-Salem, North Carolina, United States

Walter T. Ambrosius,

• Bress, Adam, University of Utah School of Medicine, Salt Lake City, Utah, United States

Adam Bress,

• Cutler, Jeffrey A., NHLBI, Washington, District of Columbia, United States

Jeffrey A. Cutler,

• Whelton, Paul K., Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States

Paul K. Whelton,

• Cushman, William C., Memphis VA Medical Center, Memphis, Tennessee, United States

William C. Cushman,

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