Objective | Test effect of target SBP < 120 mm Hg on major cardiovascular events among high-risk persons | Determine the effect of moderate vs intensive DBP control on change in creatinine clearance |
N | 4733 | 480 |
Duration | 4.7 y | 5.3 y |
Population | People with type 2 diabetes | People with type 2 diabetes |
Prevalence of cardiovascular disease | 34% | 24% in intensive group 31% in control group |
Age, y | | |
• Inclusion | Inclusion criteria of ≥ 40 with cardiovascular disease and ≥55 with at least 2 risk factors | Patients were between the ages of 40 and 74 at the time of recruitment |
• Mean age at baseline | 62 | 59 |
Drugs | Both groups able to take diuretic, β-blocker, ACE, ARB, CCB | Nisoldipine or enalapril vs placebo |
Inclusion SBP | 130-170 mm Hg if taking 0-3 antihypertensive drugs | NA |
Inclusion DBP | NA | 80-89 mm Hg while taking no medications |
Target SBP | Intensive: < 120 mm Hg Moderate: < 140 mm Hg | NA |
Target DBP | NA | Intensive: 10 mm Hg lower than on entry Moderate: 80-89 mm Hg |
Mean baseline BP | 139/76 mm Hg | 136/84 mm Hg |
Mean achieved SBP | Intensive: 119 mm Hg Moderate: 134 mm Hg | Intensive: 128 mm Hg Moderate: 137 mm Hg |
Mean achieved DBP | Intensive: 64 mm Hg Moderate: 71 mm Hg | Intensive: 75 mm Hg Moderate: 81 mm Hg |
Primary outcome | Composite of MI, stroke, and cardiovascular death | Change in 24-h creatinine clearance |
Results | No difference in primary outcome | No difference in primary outcome |
No difference in most secondary outcomes with the exception of stroke | Benefit in stroke, proteinuria, retinopathy |
Comments from Canadian guidelines | We are not aware of comments from CDA5; however, CHEP4 has not changed recommendations based on ACCORD BP | CDA cites ABCD NT to support SBP target of < 130 mm Hg (grade C recommendation) while acknowledging its limitations (no statistical correction for multiple comparisons, results for some outcomes based on small numbers) |