Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA.
Department of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, CT.
Diabetes Care. 2017 Dec;40(12):1733-1738. doi: 10.2337/dc17-1366. Epub 2017 Sep 25.
We sought to determine the effect of intensive blood pressure (BP) control on cardiovascular outcomes in participants with type 2 diabetes mellitus (T2DM) and additional risk factors for cardiovascular disease (CVD).
This study was a post hoc, multivariate, subgroup analysis of ACCORD-BP (Action to Control Cardiovascular Risk in Diabetes Blood Pressure) participants. Participants were eligible for the analysis if they were in the standard glucose control arm of ACCORD-BP and also had the additional CVD risk factors required for SPRINT (Systolic Blood Pressure Intervention Trial) eligibility. We used a Cox proportional hazards regression model to compare the effect of intensive versus standard BP control on CVD outcomes. The "SPRINT-eligible" ACCORD-BP participants were pooled with SPRINT participants to determine whether the effects of intensive BP control interacted with T2DM.
The mean baseline Framingham 10-year CVD risk scores were 14.5% and 14.8%, respectively, in the intensive and standard BP control groups. The mean achieved systolic BP values were 120 and 134 mmHg in the intensive and standard BP control groups ( < 0.001). Intensive BP control reduced the composite of CVD death, nonfatal myocardial infarction (MI), nonfatal stroke, any revascularization, and heart failure (hazard ratio 0.79; 95% CI 0.65-0.96; = 0.02). Intensive BP control also reduced CVD death, nonfatal MI, and nonfatal stroke (hazard ratio 0.69; 95% CI 0.51-0.93; = 0.01). Treatment-related adverse events occurred more frequently in participants receiving intensive BP control (4.1% vs. 2.1%; = 0.003). The effect of intensive BP control on CVD outcomes did not differ between patients with and without T2DM ( > 0.62).
Intensive BP control reduced CVD outcomes in a cohort of participants with T2DM and additional CVD risk factors.
我们旨在确定强化血压（BP）控制对 2 型糖尿病（T2DM）和心血管疾病（CVD）额外风险因素患者心血管结局的影响。
这是 ACCORD-BP（糖尿病血压控制行动以降低心血管风险）参与者的事后、多变量、亚组分析。如果参与者符合 ACCORD-BP 的标准血糖控制组，并且还具有 SPRINT（收缩压干预试验）资格所需的额外 CVD 风险因素，则有资格进行分析。我们使用 Cox 比例风险回归模型来比较强化与标准 BP 控制对 CVD 结局的影响。将“SPRINT 合格”的 ACCORD-BP 参与者与 SPRINT 参与者进行汇总，以确定强化 BP 控制的效果是否与 T2DM 相互作用。
强化和标准 BP 控制组的基线Framingham 10 年 CVD 风险评分分别为 14.5%和 14.8%。强化和标准 BP 控制组的平均达到收缩压值分别为 120 和 134mmHg（<0.001）。强化 BP 控制降低了 CVD 死亡、非致死性心肌梗死（MI）、非致死性卒中和任何血运重建以及心力衰竭的复合终点（风险比 0.79；95%CI 0.65-0.96；P=0.02）。强化 BP 控制还降低了 CVD 死亡、非致死性 MI 和非致死性卒中（风险比 0.69；95%CI 0.51-0.93；P=0.01）。接受强化 BP 控制的参与者更频繁地发生治疗相关不良事件（4.1% vs. 2.1%；P=0.003）。强化 BP 控制对 CVD 结局的影响在有和没有 T2DM 的患者之间没有差异（>0.62）。
强化 BP 控制降低了 T2DM 和额外 CVD 风险因素患者的 CVD 结局。
