Intensive Blood-Pressure Control in Type 2 Diabetes | NEJM

Summary

A recent clinical trial examined the effects of intensive blood pressure control on cardiovascular outcomes in patients with type 2 diabetes and elevated systolic blood pressure. Conducted in China with nearly 13,000 participants aged 50 or older, the trial compared intensive treatment (targeting systolic blood pressure under 120 mm Hg) to standard treatment (under 140 mm Hg). Results showed significantly fewer major cardiovascular events in the intensive treatment group, with a lower incidence of strokes, heart failure, and myocardial infarctions. However, intensive treatment also led to more cases of hypotension and hyperkalemia. The study underscores the potential benefits of tighter blood pressure control in reducing cardiovascular risk in diabetic patients.

Takeaways

• 😀 Clinical guidelines recommend lowering elevated blood pressure in patients with type 2 diabetes to reduce cardiovascular disease risk.
• 😀 The effective targets for systolic blood pressure reduction in diabetes patients remain unclear.
• 😀 A new trial compared intensive blood pressure control to standard control in patients with type 2 diabetes.
• 😀 The trial included nearly 13,000 adults, aged 50 or older, with type 2 diabetes, elevated systolic blood pressure, and increased cardiovascular risk.
• 😀 Participants were assigned to either intensive antihypertensive treatment (targeting systolic BP <120 mm Hg) or standard treatment (targeting systolic BP <140 mm Hg).
• 😀 The trial had a follow-up period of up to 5 years.
• 😀 The primary outcome measured was a composite of nonfatal stroke, nonfatal myocardial infarction, heart failure treatment or hospitalization, and cardiovascular death.
• 😀 Intensive blood pressure treatment showed a significantly lower incidence of major cardiovascular events compared to standard treatment during a median follow-up of 4 years.
• 😀 Serious adverse events occurred in approximately one-third of participants in both groups, with symptomatic hypotension being more frequent in the intensive treatment group.
• 😀 Hyperkalemia was also more common in the intensive treatment group than in the standard treatment group.
• 😀 The trial concluded that intensive antihypertensive treatment significantly reduced the incidence of major cardiovascular events in patients with type 2 diabetes and elevated blood pressure.

Q & A

What is the main clinical focus of the trial mentioned in the transcript?

The trial focuses on the effect of intensive blood-pressure control in patients with type 2 diabetes, elevated blood pressure, and an increased risk of cardiovascular disease.

What was the primary outcome of the trial?

The primary outcome was a composite of the first occurrence of nonfatal stroke, nonfatal myocardial infarction, treatment or hospitalization for heart failure, or death from cardiovascular causes.

How were the participants divided in the trial?

Participants were assigned to either intensive antihypertensive treatment, targeting a systolic blood pressure of less than 120 mm Hg, or to standard treatment, targeting less than 140 mm Hg.

How long was the follow-up period for the trial?

The median follow-up period for the trial was approximately 4 years.

What was the significant finding regarding the primary outcome between the two treatment groups?

The incidence of the composite primary outcome was significantly lower in the intensive treatment group (1.65 events per 100 person-years) compared to the standard treatment group (2.09 events per 100 person-years).

What were the serious adverse events experienced by participants in the trial?

Approximately one third of the participants in each group experienced serious adverse events. However, symptomatic hypotension occurred more frequently in the intensive treatment group.

What additional adverse event was more common in the intensive treatment group?

Hyperkalemia (high potassium levels) was more common in the intensive treatment group compared to the standard treatment group.

How many participants were involved in the trial?

The trial included nearly 13,000 adults aged 50 years or older with type 2 diabetes, elevated systolic blood pressure, and an increased risk of cardiovascular disease.

What was the specific blood pressure target for the intensive treatment group?

The target for the intensive treatment group was a systolic blood pressure of less than 120 mm Hg.

What did the authors conclude based on the trial results?

The authors concluded that intensive antihypertensive treatment significantly lowered the incidence of major cardiovascular events in patients with type 2 diabetes, elevated systolic blood pressure, and an increased risk of cardiovascular disease, over approximately 4 years of follow-up.