Benefits of intensive blood pressure treatment in patients with type 2 diabetes mellitus receiving standard but not intensive glycemic control

Abstract

This study aimed to assess whether intensive blood pressure (BP) treatment has benefits in preventing cardiovascular events, including heart failure in patients with type 2 diabetes mellitus. Using the ACCORD BP trial (Action to Control Cardiovascular Risk in Diabetes Blood Pressure) data, hazard ratios for cardiovascular events with 95% confidence intervals were calculated using the Cox proportional hazard models to compare the time to the first cardiovascular event in patients receiving standard (n=2362) or intensive glycemic control (n=2371). The overall mean follow-up period was 4.5 years, and cardiovascular events were confirmed in 528 patients. The cardiovascular event risk in patients receiving standard glycemic control was significantly lower in the intensive BP treatment group than in the standard BP treatment group (hazard ratio, 0.71; 95% confidence interval, 0.56-0.90; P=0.005), whereas that in patients receiving intensive glycemic control did not differ significantly between the groups (hazard ratio, 1.06; 95% confidence interval, 0.83-1.36; P=0.61). There was a significant interaction between the BP treatment strategy and glycemic control (P=0.02). The stroke risk in patients receiving standard glycemic control was significantly lower in the intensive BP treatment group, but not in patients receiving intensive glycemic control. Although not significant, all-cause mortality in patients receiving intensive glycemic control was higher in patients receiving intensive BP treatment than in those receiving standard BP treatment (hazard ratio, 1.38; 95% confidence interval, 0.99-1.92; P=0.05). Benefits of intensive BP treatment were observed only in ACCORD BP participants receiving standard glycemic control without additional risk factors.