The Influence of Baseline Diastolic Blood Pressure on the Effects of Intensive Blood Pressure Lowering on Cardiovascular Outcomes and All-Cause Mortality in Type 2 Diabetes
- 4 May 2020
- journal article
- research article
- Published by American Diabetes Association in Diabetes Care
- Vol. 43 (8), 1878-1884
- https://doi.org/10.2337/dc19-2047
Abstract
OBJECTIVE To examine whether low baseline diastolic blood pressure (DBP) modifies the effects of intensive systolic blood pressure (SBP) lowering on cardiovascular outcomes in type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS The Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial (ACCORD BP), a two-by-two factorial randomized controlled trial, examined effects of SBP (1c N = 4,731). We examined whether effects of SBP control on cardiovascular composite were modified by baseline DBP and glycemic control. RESULTS Intensive SBP lowering decreased the risk of the cardiovascular composite (hazard ratio [HR] 0.76 [95% CI 0.59–0.98]) in the standard glycemic arm but not in the intensive glycemic arm (HR 1.06 [95% CI 0.81–1.40]). Spline regression models relating the effects of the intervention on the cardiovascular composite across the range of baseline DBP did not show evidence of effect modification by low baseline DBP for the cardiovascular composite in the standard or intensive glycemic arms. The relation between the effect of the intensive SBP intervention and baseline DBP was similar between glycemic arms for the cardiovascular composite three-way interaction (P = 0.83). CONCLUSIONS In persons with T2DM, intensive SBP lowering decreased the risk of cardiovascular composite end point irrespective of baseline DBP in the setting of standard glycemic control. Hence, low baseline DBP should not be an impediment to intensive SBP lowering in patients with T2DM treated with guideline-recommended standard glycemic control.Funding Information
- National Heart, Lung, and Blood Institute (R21-HL-145494)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01-DK-091437)
- U.S. Public Health Service (UL1-RR-025764, C06-RR-11234)
This publication has 31 references indexed in Scilit:
- J-curve revisited: an analysis of blood pressure and cardiovascular events in the Treating to New Targets (TNT) TrialEuropean Heart Journal, 2010
- Effects of Intensive Blood-Pressure Control in Type 2 Diabetes MellitusThe New England Journal of Medicine, 2010
- Effects of Combination Lipid Therapy in Type 2 Diabetes MellitusThe New England Journal of Medicine, 2010
- Effects of Intensive Glucose Lowering in Type 2 DiabetesThe New England Journal of Medicine, 2008
- Microvascular and Macrovascular Complications of DiabetesClinical Diabetes, 2008
- On-Treatment Diastolic Blood Pressure and Prognosis in Systolic HypertensionArchives of Internal Medicine, 2007
- Complex Relationship Between Blood Pressure and Mortality in Type 2 Diabetic PatientsHypertension, 2006
- Proportional hazards tests and diagnostics based on weighted residualsBiometrika, 1994
- BENEFITS AND POTENTIAL HARM OF LOWERING HIGH BLOOD PRESSUREThe Lancet, 1987
- RELATION OF REDUCTION IN PRESSURE TO FIRST MYOCARDIAL INFARCTION IN PATIENTS RECEIVING TREATMENT FOR SEVERE HYPERTENSIONThe Lancet, 1979