http://www.theheart.org/web_slides/1146197.do A randomized study,on action to control cardiovascular risk in diabetes and blood-pressure-lowering arm (ACCORD BP) in a nonblinded fashion, to intensive BP-lowering

1. ACCORD BP (Action to Control
Cardiovascular Risk in Diabetes —
Blood–Pressure-lowering arm)

2. ACCORD BP (Action to Control Cardiovascular Risk in
Diabetes — Blood–Pressure-lowering arm)
W C Cushman (Veterans Affairs Medical Center, Memphis, TN)
American College of Cardiology 2010 Scientific Sessions
• Background:
Designed to provide clinical-trial evidence to support recommendations to
lower SBP <130 mm Hg in type 2 diabetes—as advised in JNC 7 guidelines
• Population and treatment:
4733 patients with type 2 diabetes
Randomized, in a nonblinded fashion, to intensive BP-lowering with target
SBP<120 mm Hg, or standard BP lowering with target SBP<140 mm Hg
• Primary outcome:
A composite of fatal and nonfatal major CV events
SBP=systolic blood pressure

3. ACCORD BP: Results
• No significant difference in the primary end point as well as in the prespecified
secondary end points between the groups
Primary and secondary outcomesa
Outcome Intensive therapy Intensive therapy Standard therapy Standard therapy Hazard p
(n=2363), events, n (n=2363), %/y (n=2371), events, n (n=2371), %/y ratio
Primary outcome 208 1.87 237 2.09 0.88 0.20
Secondary outcomes
Nonfatal MI 126 1.13 146 1.28 0.87 0.25
Stroke
– Any 36 0.32 62 0.53 0.59 0.01
– Nonfatal 34 0.30 55 0.47 0.63 0.03
Death
– Any cause 150 1.28 144 1.19 1.07 0.55
– CV cause 60 0.52 58 0.49 1.06 0.74
a. At a median of 4.7 years

4. ACCORD BP: Commentary*
"In my opinion it's now probably reasonable to forget all about the 130-mm-Hg goal
[in diabetics], even though we didn't test that. Everything in terms of clinical-trial
evidence would suggest that 140 mm Hg is an appropriate goal . . .
There is no reason to say that we shouldn't treat [high] blood pressure in
diabetics—we should, it's extremely important to get them down to the levels at
which we have shown benefit, consistent with our standard group."
- Dr William C Cushman
*All comments from ACCORD BP: Intensive BP lowering futile in diabetics
(http://www.theheart.org/article/1054543.do)

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