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Intensive blood pressure control also benefits people with type 2 diabetes
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Intensive blood pressure control also benefits people with type 2 diabetes

CHICAGO — The cardiovascular outcome benefit of a stricter systolic blood pressure target was affirmed in patients with type 2 diabetes in the BPROAD randomized trial in China.

A target of less than 120 mm Hg reduced a composite of stroke, myocardial infarction, heart failure treatment or hospitalization, and cardiovascular death by a relative 21% compared with a target of less than 140 mm Hg during a median follow-up of 4 ,2 years, Guang. Ning, MD, PhD, of Shanghai Jiao Tong University School of Medicine, reported at American Heart Association (AHA) Scientific Sessions..

The mean blood pressure achieved in the two groups was 120.6 mm Hg in the intensive treatment group and 132.1 mm Hg in the standard treatment group. The difference translated into a 0.44% lower absolute risk per year (1.65 versus 2.09 events per 100 person-years, p<0.001) in findings published concurrently in New England Journal of Medicine.

Of all endpoint components, stroke drove the primary endpoint difference. As a secondary endpoint, fatal or nonfatal stroke occurred 21% less often with intensive blood pressure lowering than with standard endpoints (1.19 vs. 1.50 events per 100 person-years, HR 0.79, CI 95% 0.67-0.92).

Shawna Nesbitt, MD, of UT Southwestern Medical Center in Dallas and discussing the study at an AHA news conference, drew comparisons with two previous studies comparing targets of less than 120 versus 140 mm Hg systolic: The ACCORD BP studywho found a nonsignificant trend for lower rates of cardiovascular events with intensive blood pressure control in type 2 diabetes and The SPRINT trialwhich found significant benefits in a non-diabetic population.

That combination of positive and negative findings “goes against the grain,” Nesbitt said, “because the risk of cardiovascular events in diabetics is obviously much higher.”

She pointed to one potential explanation being ACCORD’s tiered enrollment design, so that lower-risk patients were reserved for the blood pressure arm of the two-by-two randomized trial.

“This study now confirms that diabetics do in fact have the same response as non-diabetics to blood pressure treatments,” she concluded.

John Buse, MD, PhD, an endocrinologist at the University of North Carolina at Chapel Hill and a leader of the ACCORD study acknowledged “several unsuccessful attempts to define a role for tighter blood pressure control to reduce cardiovascular outcomes.” in type 2 diabetes.

He agreed that “BPROAD’s demonstration of the benefit of tracking a systolic blood pressure of less than 120 mm Hg in China is an important advance for evidence in this space.”

The AHA/American College of Cardiology guidelines recommend a systolic blood pressure goal of less than 130/80 mm Hg for adults with diabetes, while the American Diabetes Association guidelines recommend a goal of less than 140/90 mm Hg for most patients with diabetes. diabetes, but below 130/90 mm Hg. Threshold of 80 mm Hg for those with higher cardiovascular risk. Ning suggested that there should now be unification of guidelines with the intensive target.

However, Buse issued a note of caution: “One thing to keep in mind is that type 2 diabetes in China is quite different from the disease in the US, with a much lower burden of obesity and greater insulin deficiency. Whether this translates to people with type 2 diabetes in the US is not certain.”

BPROAD included 12,821 patients (45.3% female) enrolled from February 2019 to December 2021 at 145 clinical facilities in China. Inclusion criteria were age 50 years or older (mean 63.8), type 2 diabetes, increased risk of cardiovascular disease, and a baseline systolic blood pressure of 130–180 mm Hg while taking antihypertensive medications or the less than 140 mm Hg while not taking antihypertensives.

Rates of serious adverse events were similar in the two groups overall, but symptomatic hypotension and hyperkalemia occurred more frequently with intensive treatment, as expected from previous studies.

Nesbitt noted that the study used the same protocol for measuring blood pressure and the same Omron devices as the SPRINT study. “In the SPRINT trial, I will point out that there was a publication that showed whether or not (the measurements) were assisted or not did not change the outcome of the trial. And so, although there are still questions about exactly how blood pressure should be measured, the result was basically the same.”

Disclosures

The study was funded by the National Key Research and Development Program of the Ministry of Science and Technology of China, National Natural Science Foundation of China, Shanghai Municipal Government, Shanghai Shenkang Hospital Development Center, Shanghai Clinical Research Center for Disease Metabolic. , Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, and Shanghai Local High-Level Universities Innovative Research Team.

Ning has disclosed no relevant industry relationships.

Nesbitt disclosed relationships with Ablative Solutions.

Buse disclosed relationships with most of the companies working in the diabetes field.

Primary source

New England Journal of Medicine

Reference source: Bi Y, et al “Intensive blood-pressure control in patients with type 2 diabetes” N Engl J Med 2024; DOI: 10.1056/NEJMoa2412006.