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Review: Intensive blood pressure control reduces stroke, but not mortality or MI, in type 2 diabetes.
MedLine Citation:
PMID:  23318339     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
QUESTION In adults with type 2 diabetes mellitus, does intensive blood pressure (BP) control improve clinical outcomes more than standard BP control? REVIEW SCOPE Included studies compared antihypertensive therapies to achieve prespecified BP targets in adults who had type 2 diabetes, and assessed ≥ 1 of mortality, myocardial infarction (MI), or stroke. Studies that assessed multifactorial interventions in which the effect of BP lowering could not be separated from the effects of other treatments were excluded. Outcomes were mortality, MI, stroke, and adverse events. REVIEW METHODS MEDLINE, EMBASE/Excerpta Medica, and Cochrane Central Register of Controlled Trials (all to Mar 2011); reference lists of identified trials and review articles; and clinicaltrials.gov and isrctn.org were searched for randomized or quasi-randomized controlled trials. Authors of published studies were contacted. 5 randomized controlled trials (RCTs) (n = 7313, mean age 53 to 62 y) with follow-up ranging from 2 to 5 years met the selection criteria. The intensive BP targets were diastolic BP (DBP) ≤ 75 mm Hg in 2 trials, DBP < 75 mm Hg in 1 trial, DBP ≤ 80 mm Hg in 1 trial, and systolic BP (SBP) < 120 mm Hg in 1 trial. Standard BP targets were DBP < 90 mm Hg in 2 trials, SBP < 140 mm Hg in 1 trial, SBP/DBP < 140/90 mm Hg in 1 trial, and 1 trial had 2 standard BP groups of DBP ≤ 85 mm Hg and ≤ 90 mm Hg. Trial size ranged from 129 to 4733 patients. MAIN RESULTS Meta-analysis showed that intensive BP targets reduced stroke but not mortality or MI (Table). Only 1 trial (ACCORD-BP, n = 4733) reported details of adverse events; the intensive BP target group had higher rates of serious adverse events than the standard BP target group (3.3% vs 1.7%, P < 0.001). CONCLUSION Intensive blood pressure control reduced stroke, but not myocardial infarction or mortality, compared with standard control in adults with type 2 diabetes.Intensive vs standard blood pressure (BP) targets in adults with type 2 diabetes*OutcomesNumber of trials (n)†Weighted event ratesMean follow-up 2 to 5 yIntensive BP targetStandard BP targetRRR (95% CI)NNT (CI)Mortality5 (6812)5.1%6.4%20% (-14 to 44)Not significantMyocardial infarction4 (6683)8.9%9.6%7% (-9 to 21)Not significantStroke4 (6683)1.9%3.1%39% (17 to 55)82 (58 to 188)*Abbreviations defined in Glossary. Weighted intensive BP target event rate, RRR, NNT, and CI calculated from control event rates and risk ratios in article using a random-effects model.†To avoid double-counting the intensive BP target group in the HOT study, the meta-analyses presented in this abstract exclude the HOT diastolic ≤ 80 mm Hg vs ≤ 85 mm Hg comparison; the results are slightly different quantitatively compared with the source article, but the overall conclusions are unchanged.
Authors:
Louise Moist
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of internal medicine     Volume:  158     ISSN:  1539-3704     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  JC5     Citation Subset:  AIM; IM    
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