Does Intensive Glucose Control Cancel Out Benefits of Systolic Blood Pressure Target <120 mm Hg in Patients With Diabetes Mellitus Participating in ACCORD?
See related article, pp 323–330
The relationship between BP and blood glucose has been known for >40 years when Leren et al1 reported positive correlations between blood glucose and systolic (r=0.21) and diastolic BP (r=0.11) in apparently healthy white men (n=14 816) between 40 and 49 years of age. However, the associations between BP and glucose received little attention until 1998. Then, results from the HOT study (Hypertension Optimal Treatment)2 and from the UKPDS (United Kingdom Prospective Diabetes Study)3 appeared addressing treatment of hypertension in patients with diabetes mellitus. Randomization was stratified for diabetes mellitus status in the HOT study with 500 patients with diabetes mellitus and hypertension in 3 treatment arms. The trend for reduction in the primary cardiovascular end point, composite cardiovascular mortality, stroke, and myocardial infarction was reduced with 50% (P=0.005) favoring a diastolic BP target of 80 mm Hg. Although this was a subgroup analysis in a randomized clinical mega trial that overall failed on the primary end point,2 the interest and awareness for hypertension in patients with diabetes mellitus escalated. Large outcome trials have subsequently been performed in patients with diabetes mellitus and hypertension.4,5 Other hypertension outcome trials comparing different drug regimens6,7 have been enriched with subgroups of many thousand patients with diabetes mellitus, though not showing that patients with hypertension and diabetes mellitus have different benefits compared with people with hypertension and no diabetes mellitus. Today, the question is mostly how aggressively BP should be treated in patients with diabetes mellitus to protect against cardiovascular and renal disease,4,5 as the BP target below 130/80 mm Hg recommended in guidelines has been questioned.
The ACCORD (Action to Control Cardiovascular Risk in Diabetes) analysis published in this issue of Hypertension8 assessed whether …