ACCORD BP (Action to ControlCardiovascular Risk in Diabetes —Blood–Pressure-lowering arm)
ACCORD BP (Action to Control Cardiovascular Risk inDiabetes — Blood–Pressure-lowering arm)W C Cushman (Veterans Affairs Medical Center, Memphis, TN)American College of Cardiology 2010 Scientific Sessions• Background: Designed to provide clinical-trial evidence to support recommendations to lower SBP <130 mm Hg in type 2 diabetes—as advised in JNC 7 guidelines• Population and treatment: 4733 patients with type 2 diabetes Randomized, in a nonblinded fashion, to intensive BP-lowering with target SBP<120 mm Hg, or standard BP lowering with target SBP<140 mm Hg• Primary outcome: A composite of fatal and nonfatal major CV eventsSBP=systolic blood pressure
ACCORD BP: Results• No significant difference in the primary end point as well as in the prespecified secondary end points between the groupsPrimary and secondary outcomesa Outcome Intensive therapy Intensive therapy Standard therapy Standard therapy Hazard p (n=2363), events, n (n=2363), %/y (n=2371), events, n (n=2371), %/y ratio Primary outcome 208 1.87 237 2.09 0.88 0.20 Secondary outcomes Nonfatal MI 126 1.13 146 1.28 0.87 0.25 Stroke – Any 36 0.32 62 0.53 0.59 0.01 – Nonfatal 34 0.30 55 0.47 0.63 0.03 Death – Any cause 150 1.28 144 1.19 1.07 0.55 – CV cause 60 0.52 58 0.49 1.06 0.74a. At a median of 4.7 years
ACCORD BP: Commentary*"In my opinion its now probably reasonable to forget all about the 130-mm-Hg goal[in diabetics], even though we didnt test that. Everything in terms of clinical-trialevidence would suggest that 140 mm Hg is an appropriate goal . . .There is no reason to say that we shouldnt treat [high] blood pressure indiabetics—we should, its extremely important to get them down to the levels atwhich we have shown benefit, consistent with our standard group." - Dr William C Cushman*All comments from ACCORD BP: Intensive BP lowering futile in diabetics(http://www.theheart.org/article/1054543.do)
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