ACCORD BP Action to control cardiovascular risk in diabetes in diabetes-blood pressure

Question 1

ACCORD BP Clinical Question

Answer 1

In patients with T2DM at high risk for CV events, does intensive BP control (SBP <120 mmHg) reduce rates of nonfatal MI, nonfatal stroke, or CV mortality when compared to standard BP control (SBP <140 mmHg)?

Question 2

ACCORD BP Bottom Line

Answer 2

In patients with T2DM at high risk for CV events, targeting SBP <120 mmHg did not reduce rates of nonfatal MI, nonfatal stroke, or CV mortality when compared to a target SBP <140 mmHg.

Question 3

ACCORD BP Design and n

Answer 3

Multicenter, randomized, controlled, open-label trial

3733

Question 4

ACCORD BP Primary outcome

Answer 4

Nonfatal MI, nonfatal stroke, or CV mortality

Question 5

ACCORD BP inclusion criteria

Answer 5

• Type 2 diabetes mellitus
• Hemoglobin A1C ≥7.5%
• Age ≥40 years with CVD
• Age ≥55 years with any of the following:
  1. Atherosclerosis
  2. Albuminuria
  3. LVH
  4. ≥2 CV risk factors (dyslipidemia, hypertension, smoking, or obesity)

Question 6

ACCORD BP exclusion criteria

Answer 6

• BMI >45 kg/m2
• Creatinine >1.5mg/dL (132.6 umol/L)
• Other serious illness
• Age ≥80 was added in 2003

Question 7

ACCORD BP Criticisms

Answer 7

1. Patients were late into disease process and may have missed opportunity for benefit (mean age 62, 34% had CV events before trial, avg 10 yrs of DM)
2. Not blinded
3. Underpowered because of the lower-than-expected rate of events
4. Duration of follow-up may not have been sufficient
5. Did not compare the JNC 7’s recommendation of 130 mmHg to 140 mmHg
6. Not powered to detect renal outcomes
7. BP lowering may have been too aggressive and caused harm
8. Few individuals of Hispanic ethnicity enrolled