Lowering BP to normal levels doesn’t help diabetics

LONDON - Lowering blood pressure to normal levels does not reduce the combined risk of fatal or nonfatal cardiovascular disease events in type 2 diabetes patients prone to such events, according to new results from the landmark Action to Control Cardiovascular Risk in Diabetes (ACCORD) clinical trial.imilarly, treating multiple blood lipids with combination drug therapy of a fibrate and a statin did not reduce the combined risk of cardiovascular disease events more than treatment with statin alone.

ACCORD, the study of more than 10,000 participants, is one of the largest studies ever conducted in adults with type 2 diabetes who were at especially high risk of cardiovascular events, such as heart attacks, stroke, or death from cardiovascular disease.

The multicenter clinical trial tested three potential strategies to lower the risk of major cardiovascular events-intensive control of blood sugar, intensive control of blood pressure, and treatment of multiple blood lipids.

The lipids targeted for intensive treatment were high density lipoprotein (HDL) cholesterol and triglycerides, in addition to standard therapy of lowering low density lipoprotein (LDL) cholesterol.

“ACCORD provides important evidence to help guide treatment recommendations for adults with type 2 diabetes who have had a heart attack or stroke or who are otherwise at especially high risk for cardiovascular disease. This information provides guidance to avoid unnecessarily increasing treatment that provides limited benefit and potentially increases the risk of adverse effects,” said Dr. Susan B. Shurin.

For the study, the researchers randomly assigned 4,733 participants with elevated blood pressure to a target systolic blood pressure of either less than 120 mmHg (the intensive group) or to less than 140 mmHg (the standard group).

A variety of FDA-approved blood pressure medications was used to reach blood pressure goals.

After an average follow-up of about five years, the researchers found no significant differences between the intensive group and the standard group in rates of a combined endpoint including nonfatal heart attack, nonfatal stroke, or cardiovascular death.

Lowering blood pressure to below the standard level significantly cut the risk of stroke by about 40 percent.

The intensive blood pressure group had 36 strokes, compared to 62 strokes in the standard group.

However, the researchers warned that participants in the intensive blood pressure group were more likely to have complications such as abnormally low blood pressure or high levels of blood potassium.

“Our results provide no conclusive evidence that targeting a normal systolic blood pressure compared with targeting a systolic blood pressure of less than 140 mmHg lowers the overall risk of major cardiovascular events in high risk adults with type 2 diabetes. However, the study suggests that lower blood pressure levels in patients like those in ACCORD may reduce the risk of stroke. This finding is consistent with other blood pressure trials,” said Dr. William C. Cushman, lead author of the study.

“Our results also showed a higher risk of serious adverse events with more intensive blood pressure control. Diabetic patients should discuss their systolic blood pressure goal with their health care provider and, as with any treatment, weigh the risks and benefits of various treatments to lower blood pressure,” added Cushman.

The results of the ACCORD clinical trials appear online in the New England Journal of Medicine (NEJM). (ANI)