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The ACCORD Blood Pressure trial compared an intensive systolic blood-pressure target below 120 mmHg with a standard target below 140 mmHg in people with type 2 diabetes. Intensive treatment did not significantly reduce the primary composite of major cardiovascular events, although stroke was reduced. Treatment was associated with more serious adverse events attributed to blood-pressure lowering. The study is important for clinicians because patients with diabetes are heterogeneous and may derive different absolute benefits from tighter pressure control depending on baseline cardiovascular risk. For general physicians, the practical message is to individualize targets rather than extrapolate SPRINT wholesale into every patient with diabetes. Accurate measurements, assessment of albuminuria, kidney function and cardiovascular disease, and monitoring for orthostatic symptoms are essential. The study also illustrates that intensification should be judged on a balance of benefits and harms, not on the achievement of a numeric target alone.
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The ACCORD Blood Pressure trial compared an intensive systolic blood-pressure target below 120 mmHg with a standard target below 140 mmHg in people with type 2 diabetes. Intensive treatment did not significantly reduce the primary composite of major cardiovascular events, although stroke was reduced. Treatment was associated with more serious adverse events attributed to blood-pressure lowering. The study is important for clinicians because patients with diabetes are heterogeneous and may derive different absolute benefits from tighter pressure control depending on baseline cardiovascular risk. For general physicians, the practical message is to individualize targets rather than extrapolate SPRINT wholesale into every patient with diabetes. Accurate measurements, assessment of albuminuria, kidney function and cardiovascular disease, and monitoring for orthostatic symptoms are essential. The study also illustrates that intensification should be judged on a balance of benefits and harms, not on the achievement of a numeric target alone.
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