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Achieving target SBP for lowering the risk of major adverse cardiovascular events in persons with diabetes mellitus

Ó Hartaigh, Bríaina; Szymonifka, Jackieb; Okin, Peter, M.c

doi: 10.1097/HJH.0000000000001515
ORIGINAL PAPERS: Diabetes
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Aim: To test the efficacy of achieving target SBP less than 120 mmHg, or less than 140 mmHg, for lowering the risk of major adverse cardiovascular events (MACE) in persons with diabetes mellitus.

Method: The study comprised 4732 [mean ± SD age: 63 ± 7 years; 2258 (48%) women] persons with advanced diabetes mellitus. Participants randomly assigned to achieve intensive (<120 mmHg) or standard (<140 mmHg) SBP control were grouped according to whether or not they achieved their respective SBP goal. MACE consisted of nonfatal myocardial infarction, nonfatal stroke, and death from cardiovascular causes.

Results: During a median 5.0 (interquartile range: 4.2–5.7) years, 1939 (82%) and 2038 (86%) persons achieved SBP targets less than 120 and less than 140 mmHg in each treatment arm, respectively. Overall, 208 (9%) and 237 (10%) persons in the intensive and standard treatment arms experienced MACE. In the intensive treatment arm, multivariable Cox regression revealed no significant reduction in risk of MACE for those who achieved a target SBP less than 120 mmHg. In the standard treatment arm, those who achieved a target SBP less than 140 mmHg displayed a substantial reduction in risk of MACE (hazard ratio = 0.65, P = 0.005), all-cause death (hazard ratio = 0.64, P = 0.02), and nonfatal stroke (hazard ratio = 0.47, P = 0.02) as compared with those whose achieved SBP was 140 mmHg or higher.

Conclusion: Achieving a standard SBP goal between 120 and 140 mmHg may prove useful for lowering cardiovascular risk in persons with diabetes mellitus. Achieving a target SBP less than 120 mmHg does not appear to mitigate risk.

Clinical trial registration: ClinicalTrials.gov # NCT00000620 (https://clinicaltrials.gov/ct2/results?term=NCT00000620&Search=Search).

aDalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College

bDepartment of Medicine, Hospital for Special Surgery

cDivision of Cardiology, Weill Cornell Medicine, New York, New York, USA

Correspondence to Peter M. Okin, MD, Division of Cardiology, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10065, USA. Tel: +1 212 746 4688; fax: +1 212 746 8473; e-mail: pokin@med.cornell.edu

Abbreviations: CI, confidence interval; ACCORD BP, Action to Control Cardiovascular Risk in Diabetes Blood Pressure; ACE, angiotensin-converting enzyme; ADA, American Diabetes Association; ARB, angiotensin II receptor blockers; BP, blood pressure; CCB, calcium-channel blockers; CCN, Clinical Center Network; CVD, cardiovascular disease; DM, diabetes mellitus; GED, general equivalency diploma; GFR, glomerular filtration rate; HR, hazard ratio; IQR, interquartile range; MACE, major adverse cardiovascular events; MI, myocardial infarction; NHLBI, National Heart Lung and Blood Institute; RR, relative risk

Received 19 May, 2017

Revised 29 June, 2017

Accepted 13 July, 2017

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