No Benefit to Intensive Blood Pressure Control in Diabetes

03/16/2010 - News

No Benefit to Intensive Blood Pressure Control in Diabetes

By: June Chen, MD

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New data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial shows that there is no benefit in intensive blood pressure lowering below 120 mm Hg in patients with diabetes. This surprising finding about blood pressure control in diabetes was published online in the New England Journal of Medicine.

The ACCORD blood pressure trial was designed to test the effect of a target systolic blood pressure below 120 mm Hg on major cardiovascular events, such as heart attack, stroke, or cardiovascular-related death, among high-risk patients with type 2 diabetes. A total of 4733 participants with type 2 diabetes wererandomly assigned to intensive therapy, targeting a systolic blood pressure of less than 120 mm Hg, or standard therapy, targetinga systolic blood pressure of less than 140 mm Hg. After 1 year, the mean systolic blood pressure was 119.3mm Hg in the intensive-therapy group and 133.5 mm Hg in thestandard-therapy group. ACCORD investigators found that there was no difference in the occurrence of major cardiovascular events between the intensive and standard therapy groups. Although stroke was less likely among the participants in the intensive blood pressure control group, the likelihood of adverse events due to blood pressure-lowering therapy was also higher.

Diabetes increases the risk of cardiovascular disease at every level of systolic blood pressure, even at blood pressure levels that are considered to be in the high-normal range. Based on this, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommended beginning drug treatment in patients with diabetes who have a systolic blood pressure  of 130 mm Hg or higher, with a goal of lowering systolic blood pressure to below 130 mm Hg. However, there is limited evidence from randomized clinical trials to support these recommendations. Based on this data from the ACCORD blood pressure trial, it seems that, while blood pressure control is an important part of diabetes management, a blood pressure goal of 140 mm Hg may be an appropriate goal for patients with diabetes.

 

Source:

NEJM. Published online 14 March 2010.

 

Created on: 03/16/2010
Reviewed on: 03/16/2010

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Anonymous wrote 11 weeks 3 days ago

Actually part of the concerning data in recent studies has been that statins used to lower cholesterol levels may promote diabetes. In addition the whole notion of lowering cholesterol is being questioned. The Framingham study evidence underlying the “lipid hypothesis” was never strong to start with. Since then a massive lipid lowering campaign has shown no effect on heart disease rates. While an elegant and seemingly intuitive hypothesis, more and more openly people are rightly questioning the wisdom of the cholesterol lowering campaign. http://healthjournalclub.blogspot.com/