ACCORD BP
Trial question
What is the effect of intensive BP control in patients with T2DM mellitus at high risk for cardiovascular events?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
48.0% female
52.0% male
N = 4733
4733 patients (2258 female, 2475 male)
Inclusion criteria: patients with T2DM at high risk for cardiovascular events
Key exclusion criteria: BMI > 45, a serum creatinine level > 1.5 mg/dL (132.6 mcmol/L), and other serious illness
Interventions
N=2362 intensive BP control (targeting a systolic pressure of < 120 mmHg)
N=2371 standard BP control (targeting a systolic pressure of < 140 mmHg)
Primary outcome
Nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes
1.87
2.09
2.1 %
1.6 %
1.0 %
0.5 %
0.0 %
Intensive blood pressure control
Standard blood pressure control
No significant difference ↔
No significant difference in nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes (1.87% vs. 2.09%; HR 0.88, 95% CI 0.73 to 1.06)
Secondary outcomes
No significant difference in annual death from any cause (1.28% vs. 1.19%; HR 1.07, 95% CI 0.85 to 1.35)
Significant decrease in stroke at 1 year (0.32% vs. 0.53%; HR 0.59, 95% CI 0.39 to 0.89)
Safety outcomes
Significant differences in serious adverse events attributed to antihypertensive treatment (3.3% vs. 1.3%, p < 0.001).
Conclusion
In patients with T2DM at high risk for cardiovascular events, intensive BP control was not superior to standard BP control with respect to nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes.
Reference
ACCORD Study Group, Cushman WC, Evans GW et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010 Apr 29;362(17):1575-85.
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