期刊
JOURNAL OF THE AMERICAN HEART ASSOCIATION
卷 7, 期 18, 页码 -出版社
WILEY
DOI: 10.1161/JAHA.118.009326
关键词
cardiovascular outcomes; diabetes mellitus; high blood pressure; hypertension
资金
- National Institute of Diabetes and Digestive and Kidney Diseases [R01 DK091437, R21 DK106574]
- University of Utah Study Design and Biostatistics Center (Public Health Services from the National Center for Research Resources) [UL1-RR025764, C06-RR11234]
- National Institutes of Health
- National Heart, Lung, and Blood Institute
- National Institute on Aging
- National Institute of Neurological Disorders and Stroke [HHSN268200900040C, HHSN268200900046C, HHSN268200900047C, HHSN268200900048C, HHSN268200900049C, A-HL-13-002-001]
- National Center for Advancing Translational Science: Case Western Reserve University [UL1TR000439]
- National Center for Advancing Translational Science: Ohio State University [UL1RR025755]
- National Center for Advancing Translational Science: University of Pennsylvania [UL1RR024134, UL1TR000003]
- National Center for Advancing Translational Science: Boston University [UL1RR025771]
- National Center for Advancing Translational Science: Stanford University [UL1TR000093]
- National Center for Advancing Translational Science: Tufts University [UL1RR025752, UL1TR000073, UL1TR001064]
- National Center for Advancing Translational Science: University of Illinois [UL1TR000050]
- National Center for Advancing Translational Science: University of Pittsburgh [UL1TR000005]
- National Center for Advancing Translational Science: University of Texas Southwestern [9U54TR000017-06]
- National Center for Advancing Translational Science: University of Utah [UL1TR000105-05]
- National Center for Advancing Translational Science: Vanderbilt University [UL1 TR000445]
- National Center for Advancing Translational Science: George Washington University [UL1TR000075]
- National Center for Advancing Translational Science: University of California, Davis [UL1 TR000002]
- National Center for Advancing Translational Science: University of Florida [UL1 TR000064]
- National Center for Advancing Translational Science: University of Michigan [UL1TR000433]
- National Center for Advancing Translational Science: Tulane University Centers of Biomedical Research Excellence Award National Institute of General Medical Sciences [P30GM103337]
Background-Intensive systolic blood pressure (SBP) lowering significantly reduced cardiovascular disease (CVD) events in SPRINT (Systolic Blood Pressure Intervention Trial) but not in ACCORD BP (Action to Control Cardiovascular Risk in Diabetes Blood Pressure). Methods and Results-SPRINT tested the effects of intensive (<120 mm Hg) versus standard (<140 mm Hg) SBP goals on CVD events and all-cause mortality. Using 292 factorial design, ACCORD BP tested the same SBP intervention in addition to an intensive versus standard glycemia intervention. We compared the effects of intensive SBP lowering on the composite CVD end point and all-cause mortality in SPRINT with its effects within each of the glycemia arms in ACCORD BP. Intensive SBP lowering decreased the hazard of the composite CVD end point similarly in SPRINT (hazard ratio: 0.75; 95% confidence interval, 0.64-0.89) and in the ACCORD BP standard glycemia arm (hazard ratio: 0.77; 95% confidence interval, 0.63-0.95; interaction P=0.87). However, the effect of intensive SBP lowering on the composite CVD end point in the ACCORD BP intensive glycemia arm (hazard ratio: 1.04; 95% confidence interval, 0.83-1.29) was significantly different from SPRINT (interaction P=0.023). Patterns were similar for all-cause mortality. Conclusions-The effects of intensive SBP control on CVD events and all-cause mortality were similar in patients without diabetes mellitus and in those with diabetes mellitus on standard glycemic control. An interaction between intensive SBP lowering and intensive glycemic control may have masked beneficial effects of intensive SBP lowering in ACCORD BP.
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