- In people with type 2 diabetes (T2D), intensive reductions in systolic BP (SBP) are linked to decreased risk for a cardiovascular disease (CVD) composite endpoint.
- Benefit is seen regardless of baseline diastolic BP (DBP) with standard glycemia, although risk increases slightly with low DBP and intensive glycemic control.
Why this matters
- In T2D, low DBP has been linked to worse CVD outcomes, leaving the safety of pushing SBP to
- Randomized, controlled Action to Control Cardiovascular Risk in Diabetes Blood Pressure (ACCORD BP) trial examined effects of SBP (
- Funding: National Center for Research Resources.
- Intensive SBP reductions were associated with decreased CVD composite risk (HR; 95% CI) with standard glycemic control:
- 0.76 (0.59-0.98).
- Reduction was not seen with intensive glycemic control:
- 1.06 (0.81-1.40).
- The effect of SBP intervention on CVD outcome was not related to baseline DBP with either standard glycemia (P=.67) or intensive glycemia (P=.85).
- Intensive SBP intervention and baseline DBP showed similar associations for CVD composite risk between the 2 glycemic control groups (3-way interaction P=.83).
- In the intensive glycemia group, all-cause-mortality risk (HR; 95% CIs) with intensive SBP lowering, by baseline DBP:
- ≤70 mmHg: 1.93 (1.18-3.14).
- >70 mmHg: 0.99 (0.64-1.53).
- Post hoc.