ACC 2010 - ACCORD BP: Intensive BP lowering futile in diabetics
New data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study show that there is no benefit to be gained in diabetics from intensively lowering their systolic blood pressure to a goal of <120 mm Hg .
There was no difference in the primary end point—a composite of fatal and nonfatal major cardiovascular events—between this group and those who received standard antihypertensive therapy to get their pressure down to <140 mm Hg, said lead author Dr William C Cushman (Veterans Affairs Medical Center, Memphis, TN), who presented the results at a late-breaking clinical-trials session here at the American College of Cardiology (ACC) 2010 Scientific Sessions; they were simultaneously published online in the New England Journal of Medicine.
To heartwire, Cushman admitted he was surprised by the results: "We wouldn't have done the study if we didn't think there was a reason to think it might be beneficial." But he countered, "I've said all along, that whichever the answer is, it is extremely important. If it doesn't show benefit, we should not be aggressive, because it's hard enough to get diabetics to below 140 mm Hg, so this is a good answer."
Also presented today during the same late-breaking clinical-trials session was a retrospective analysis of the INVEST trial. This showed that diabetic patients with coronary artery disease whose systolic blood pressure was lowered to 130 to 140 mm Hg had a better outcome than those with systolic pressures over 140 mm Hg. But reduction below 130 mm Hg did not appear to offer any additional benefit and those patients had a higher mortality rate.
No justification for target below 120 mm Hg in diabetics?
I've said all along, that whichever the answer is, it is extremely important.
In an editorial accompanying the published ACCORD BP study , Dr Peter M Nilsson (University Hospital, Malmö, Sweden) agrees: "The main conclusion to draw from this study must be that a systolic BP target below 120 mm Hg in patients with type 2 diabetes is not justified by the evidence."
Nilsson added that with the conclusion of the ACCORD study—which as well as this ACCORD BP trial included the ACCORD lipid trial, also reported here at the ACC meeting—a period of three landmark studies (UKPDS, ADVANCE, and ACCORD) has now come to an end. "We learn from the completed ACCORD study that flexible goals should probably be applied to the control of hyperglycemia, blood pressure, and dyslipidemia in patients with type 2 diabetes, taking into account individual clinical factors of importance," he states.