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ACCORD: Intensive BP, combined lipid therapies do not help adults with diabetes
Date:3/14/2010

40 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, 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. There were 208 cardiovascular events in the intensive group and 237 events in the standard group.

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. The researchers caution, however, 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. They noted 77 events in the intensive groups compared to 30 in the standard group. In addition, some laboratory measures of kidney function were worse in the intensive therapy group, but there was no difference in the rates of kidney failure.

"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," said William C. Cushman, M.D., chief of the Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, Tenn., and lead author. "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."

"Our results also showed a higher risk of serious adverse events with more intensive blood pressure control," Cushman added. "Diabetic patients should discuss their systolic blood pressure goal with their health care provider and, as with any treatment, wei
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