<b><i>Objective:</i></b> 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).
<p><b><i>Research Design and Methods:</i></b> The Action to
Control Cardiovascular Risk in Diabetes Blood Pressure trial (ACCORD BP),a 2X2
factorial randomized controlled trial, examined effects of SBP (<120 vs.
<140 mmHg) and glycemic (HbA1C < 6% vs. 7.0–7.9% (<42 vs 53-63
mmol/mol)) control on cardiovascular events in T2DM (N=4731). We
examined whether effects of SBP control on cardiovascular composite was modified
by baseline DBP and glycemic control. </p>
<p><b><i>Results: </i></b>Intensive SBP lowering decreased the risk of the
cardiovascular composite (HR 0.76, 95% CI 0.59 to 0.98) in the standard
glycemic arm but not in the intensive glycemic arm (HR=1.06, 95% CI 0.81 to
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
(3-way interaction p-value = 0.83).</p>
<p><b><i>Conclusions:
</i></b>in
persons with T2DM, intensive SBP lowering decreased the risk of cardiovascular
composite endpoint 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 T2DM patients treated with guidelines recommended standard
glycemic control. </p>
Impact of Intensive Glycemic Control on the Incidence of Atrial Fibrillation and Associated Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus (from the Action to Control Cardiovascular Risk in Diabetes Study)
