The ACCORD Study Group New England Journal of Medicine March 14, 2010
Full Text Link : http://content.nejm.org/cgi/content/full/NEJMoa1001286
ABSTRACT
Background There is no evidence from randomized trials to supporta strategy of lowering systolic blood pressure below 135 to140 mm Hg in persons with type 2 diabetes mellitus. We investigatedwhether therapy targeting normal systolic pressure (i.e., <120mm Hg) reduces major cardiovascular events in participants withtype 2 diabetes at high risk for cardiovascular events.
Methods A total of 4733 participants with type 2 diabetes wererandomly assigned to intensive therapy, targeting a systolicpressure of less than 120 mm Hg, or standard therapy, targetinga systolic pressure of less than 140 mm Hg. The primary compositeoutcome was nonfatal myocardial infarction, nonfatal stroke,or death from cardiovascular causes. The mean follow-up was4.7 years.
Results After 1 year, the mean systolic blood pressure was 119.3mm Hg in the intensive-therapy group and 133.5 mm Hg in thestandard-therapy group. The annual rate of the primary outcomewas 1.87% in the intensive-therapy group and 2.09% in the standard-therapygroup (hazard ratio with intensive therapy, 0.88; 95% confidenceinterval [CI], 0.73 to 1.06; P=0.20). The annual rates of deathfrom any cause were 1.28% and 1.19% in the two groups, respectively(hazard ratio, 1.07; 95% CI 0.85 to 1.35; P=0.55). The annualrates of stroke, a prespecified secondary outcome, were 0.32%and 0.53% in the two groups, respectively (hazard ratio, 0.59;95% CI, 0.39 to 0.89; P=0.01). Serious adverse events attributedto antihypertensive treatment occurred in 77 of the 2362 participantsin the intensive-therapy group (3.3%) and 30 of the 2371 participantsin the standard-therapy group (1.3%) (P<0.001).
Conclusions In patients with type 2 diabetes at high risk forcardiovascular events, targeting a systolic blood pressure ofless than 120 mm Hg, as compared with less than 140 mm Hg, didnot reduce the rate of a composite outcome of fatal and nonfatalmajor cardiovascular events. (ClinicalTrials.gov number, NCT00000620 [ClinicalTrials.gov] .)
(download full text : pdf below)
