Abstract 13850: Achievement of Target Systolic Blood Pressure for Lowering the Risk of Major Adverse Cardiovascular Events: From the Action to Control Cardiovascular Risk in Diabetes Blood Pressure Trial

Abstract

Background: Prior epidemiologic studies have documented deleterious effects of more intensive systolic blood pressure (SBP) lowering in persons with diabetes mellitus (DM). Yet, whether the risk of adverse cardiovascular events might improve, as a function of achieving target SBP goals, remains to be elucidated. Objective: To test the efficacy of achieving target SBP less than 120 mm Hg, or below 140 mm Hg (versus those unable to achieve target SBP), for offsetting the risk of major adverse cardiovascular events (MACE). Methods: Data from the ACCORD BP trial were utilized, which comprised 4,732 (mean±SD age: 63±7 years; 2,258 [48%] women) persons presenting with advanced DM. Participants were randomly assigned to achieve either intensive (<120 mm Hg) or standard (<140 mm Hg) SBP control in an effort to offset the risk of MACE - defined as a composite of non-fatal myocardial infarction, non-fatal stroke, and death from cardiovascular causes. Results: During a median follow-up of 5.0 (interquartile range: 4.2-5.7) years, 1,939 (82%) and 2,038 (86%) persons achieved SBP targets below 120 mm Hg and 140 mm Hg in each treatment arm, respectively. In total, 208 (9%) and 237 (10%) persons belonging to the intensive and standard treatment arms experienced the composite endpoint. Multivariable Cox regression analyses revealed no significant reduction in risk of MACE for those in the intensive treatment arm, who achieved a target SBP below 120 mm Hg. Conversely, those in the standard treatment arm who achieved a target SBP of less than 140 mm Hg displayed a substantial reduction in risk of MACE (HR = 0.65, 95% CI: 0.48-0.88, P =0.005), all-cause death (HR = 0.64, 95% CI: 0.43-0.94, P =0.02), and non-fatal stroke (HR = 0.47, 95% CI: 0.26-0.87, P =0.02). Conclusion: Achieving a standard SBP goal between 120-140 mm Hg may prove useful for lowering the burden of cardiovascular risk in persons with DM, whereas achieving a target SBP <120 mm Hg does not appear to reduce risk.