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Abstract: FR-PO1020

The Influence of Baseline Diastolic Blood Pressure on the Effects of Intensive Blood Pressure Lowering on All-Cause Mortality 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

The Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial (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 cardiovascular events and all-cause mortality (ACM) in T2DM (N = 4714). We examined whether the effects of INT SBP lowering on ACM was modified by baseline DBP stratified by the GLY arm.

Results

There were 292 ACM events/ 23,326 years of follow-up. Lower baseline DBP was associated with increased risk of ACM (Fig 1). Hazard ratios for INT SBP lowering in the STD and INT GLY arms were 0.84 (95% CI 0.60 to 1.17) and 1.34 (95% CI 0.97 to 1.84), respectively. Linear interaction p-value for SBP intervention and baseline DBP was not significant in the STD GLY arm (p = 0.40) but significant in INT GLY arm (p=0.01). In those with DBP ≤70 mmHg, INT SBP lowering appeared not harmful in the STD GLY arm but deleterious in the INT GLY arm (Fig 2).

Conclusion

Low baseline DBP was associated with increased risk of ACM in T2DM. In persons with baseline DBP ≤70 mm Hg, INT SBP lowering increased ACM in the setting of INT GLY but not STD GLY.

Funding

  • NIDDK Support