Effects of Blood Pressure Lowering on Clinical Outcomes According to Baseline Blood Pressure and Cardiovascular Risk in Patients With Type 2 Diabetes Mellitus

Faisal Rahman, John W. McEvoy, Toshiaki Ohkuma, Michel Marre, Pavel Hamet, Stephen Harrap, Giuseppe Mancia, Anthony Rodgers, Elizabeth Selvin, Bryan Williams, Paul Muntner, John Chalmers, Mark Woodward

Research output: Contribution to journalArticle

Abstract

The optimal blood pressure (BP) goal in patients with diabetes mellitus remains controversial. We examined whether benefits and risks of intensified antihypertensive therapy in diabetes mellitus are influenced by either baseline BP or cardiovascular disease (CVD) risk. We studied 10 948 people with diabetes mellitus, at moderate-to-high risk, in the ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation). Cox models were used to determine whether baseline BP category or CVD risk modified the outcomes of combination perindopril-indapamide treatment, compared with placebo. During 4.3 years of follow-up, treatment with perindopril-indapamide versus placebo reduced mortality and major vascular (macrovascular or microvascular) events. There was no evidence of differences in these effects, regardless of baseline systolic BP (evaluated down to <120 mm Hg; P for heterogeneity, 0.85), diastolic BP (evaluated down to <70 mm Hg; P=0.49), or whether 10-year CVD risk was ≥20% or <20% ( P=0.08). The effects of randomized treatment on discontinuation of treatment because of cough or hypotension/dizziness were also statistically consistent across subgroups defined by baseline BP and CVD risk (all P ≥0.08). Adults with diabetes mellitus appear to benefit from more intensive BP treatment even at levels of BP and CVD risk that some guidelines do not currently recommend for intervention. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT00751972.

Original languageEnglish (US)
Pages (from-to)1291-1299
Number of pages9
JournalHypertension (Dallas, Tex. : 1979)
Volume73
Issue number6
DOIs
StatePublished - Jun 1 2019

Fingerprint

Type 2 Diabetes Mellitus
Blood Pressure
Cardiovascular Diseases
Hematologic Diseases
Diabetes Mellitus
Indapamide
Perindopril
perindopril drug combination indapamide
Therapeutics
Placebos
Gliclazide
Dizziness
Vascular Diseases
Proportional Hazards Models
Cough
Hypotension
Antihypertensive Agents
Blood Vessels
Clinical Trials
Guidelines

Keywords

  • adult
  • cardiovascular diseases
  • diabetes mellitus
  • humans
  • risk

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Effects of Blood Pressure Lowering on Clinical Outcomes According to Baseline Blood Pressure and Cardiovascular Risk in Patients With Type 2 Diabetes Mellitus. / Rahman, Faisal; McEvoy, John W.; Ohkuma, Toshiaki; Marre, Michel; Hamet, Pavel; Harrap, Stephen; Mancia, Giuseppe; Rodgers, Anthony; Selvin, Elizabeth; Williams, Bryan; Muntner, Paul; Chalmers, John; Woodward, Mark.

In: Hypertension (Dallas, Tex. : 1979), Vol. 73, No. 6, 01.06.2019, p. 1291-1299.

Research output: Contribution to journalArticle

Rahman, F, McEvoy, JW, Ohkuma, T, Marre, M, Hamet, P, Harrap, S, Mancia, G, Rodgers, A, Selvin, E, Williams, B, Muntner, P, Chalmers, J & Woodward, M 2019, 'Effects of Blood Pressure Lowering on Clinical Outcomes According to Baseline Blood Pressure and Cardiovascular Risk in Patients With Type 2 Diabetes Mellitus', Hypertension (Dallas, Tex. : 1979), vol. 73, no. 6, pp. 1291-1299. https://doi.org/10.1161/HYPERTENSIONAHA.118.12414
Rahman, Faisal ; McEvoy, John W. ; Ohkuma, Toshiaki ; Marre, Michel ; Hamet, Pavel ; Harrap, Stephen ; Mancia, Giuseppe ; Rodgers, Anthony ; Selvin, Elizabeth ; Williams, Bryan ; Muntner, Paul ; Chalmers, John ; Woodward, Mark. / Effects of Blood Pressure Lowering on Clinical Outcomes According to Baseline Blood Pressure and Cardiovascular Risk in Patients With Type 2 Diabetes Mellitus. In: Hypertension (Dallas, Tex. : 1979). 2019 ; Vol. 73, No. 6. pp. 1291-1299.
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