Very Intensive Blood Pressure Control Does Not Clearly Reduce Combined Incidence of Cardiovascular Events

Abstract

ACCORD Study Group: Cushman WC, Evans GW, Byington RP, Goff DC Jr, Grimm RH Jr, Cutler JA, Simons-Morton DG, Basile JN, Corson MA, Probstfield JL, Katz L, Peterson KA, Friedewald WT, Buse JB, Bigger JT, Gerstein HC, Ismail-Beigi F: Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 362:1575–1585, 2010 Design. A randomized, controlled trial within a factorial trial that also compared intensive versus conventional glycemic control. Subjects. Subjects included a total of 4,733 participants with type 2 diabetes who were either older than 40 years of age with a history of cardiovascular disease (CVD) or older than 55 years of age with no history of cardiovascular events but increased CVD risk. Participants had systolic blood pressure readings at entry between 130 and 180 mmHg and were on three or fewer antihypertensive medications. Patient had a mean age of 62 years; 48% were female, 60% were white, 24% were African American, and 34% had a history of CVD. The mean systolic blood pressure at entry was 139 mmHg in each group. Methods. Participants were randomized to either intensive (target systolic blood pressure 120 mmHg at a visit. In the standard therapy group, therapy was augmented (increased dosage or addition of new medication) if systolic blood pressure was > 160 mmHg at one visit or > 140 mmHg at two consecutive visits and was down-titrated if systolic blood pressure was < …