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Abstract: FR-PO1015

The Influence of Baseline Diastolic Blood Pressure on the Effects of Intensive Blood Pressure Lowering on Cardiovascular Outcomes in Type 2 Diabetes Mellitus

Session Information

Category: Hypertension and CVD

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

Authors

  • Ilkun, Olesya, 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
  • Wei, Guo, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Boucher, Robert E., 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
  • Ambrosius, Walter T., Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
  • Whelton, Paul K., Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Beddhu, Srinivasan, University of Utah School of Medicine, Salt Lake City, Utah, United States
Background

Intensive (INT) compared to standard (STD) systolic blood pressure (SBP) control might be harmful in persons with low baseline diastolic blood pressure (DBP) and type 2 diabetes mellitus (T2DM).

Methods

ACCORD BP was a 2X2 factorial design RCT that examined the effects of SBP control (<120mmHg vs. <140 mmHg) and glycemia (GLY) control (HbA1C goal < 6% vs. 7.0–7.9%) on a primary cardiovascular disease (CVD) composite outcome in T2DM (N = 4714). We examined whether the effects of INT SBP lowering on CVD was modified by baseline DBP stratified by the GLY arm.

Results

There were 689 CVD events/ 21,389 years of follow-up. Lower baseline DBP was associated with increased risk of CVD composite (Fig 1). INT SBP lowering decreased the risk of the CVD composite in the STD GLY arm (HR 0.76, 95% CI 0.62 to 0.93) but not in INT GLY arm (HR 1.05, 95% CI 0.85 to 1.31). Linear interaction p-values for SBP intervention and baseline DBP were not significant in the STD (p = 0.58) or INT (p=0.78) GLY arms. The effects of INT SBP lowering on CVD composite in those with DBP ≤70 mmHg compared to those with DBP > 70 mmHg were similar within the STD or INT GLY arms (Fig 2).

Conclusion

Low baseline DBP was associated with increased risk of CVD composite in T2DM. However, there was no evidence that the beneficial effects of INT SBP lowering on CVD events in STD GLY arm was modified by low baseline DBP.

Funding

  • NIDDK Support