Intensive Blood Pressure Treatment Does Not Improve Cardiovascular Outcomes in Centrally Obese Hypertensive Individuals With Diabetes The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure Trial

• Type of Material: Article
• Authors: Joshua Barzilay, Emory University; Annie G. Howard, Wake Forest School of Medicine; Gregory W Evans, Wake Forest School of Medicine; Jerome L. Fleg, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute; Robert M. Cohen, University of Cincinnati; Gillian L. Booth, University of Toronto; Angela R. Kimel, Wake Forest School of Medicine; Carolyn F. Pedley, Wake Forest School of Medicine; William C. Cushman, Veterans Affairs Medical Center
• Language: English
• Date: 2012-07-01
• Publisher: American Diabetes Association
• Publication Version: Final Published Version
• Copyright Statement: © 2012 by the American Diabetes Association.
• License: Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.2337/dc11-1827
• Title of Journal or Parent Work: Diabetes Care
• ISSN: 0149-5992
• Volume: 35
• Issue: 7
• Start Page: 1401
• End Page: 1405
• Grant/Funding Information: This study was supported by contracts from the National Heart, Lung, and Blood Institute (N01-HC-95178, N01-HC-95179, N01-HC-95180, N01-HC-95181, N01-HC-95182, N01-HC-95183, N01-HC-95184 and IAA#Y1-HC-9035 and IAA#Y1-HC-1010).; Other components of the National Institutes of Health, including the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute on Aging, and the National Eye Institute, contributed funding. The Centers for Disease Control and Prevention funded substudies within ACCORD on cost-effectiveness and health-related quality of life. General Clinical Research Centers provide support at many sites.
• Keywords: Life Sciences & Biomedicine; Science & Technology; DISEASE; TO-HEIGHT RATIO; Endocrinology & Metabolism; ENDOCRINOLOGY & METABOLISM; COHORT; MELLITUS
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

OBJECTIVE - The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure Trial reported no differences in most cardiovascular disease (CVD) outcomes between intensive and standard blood pressure therapy in individuals with diabetes mellitus (DM) and hypertension. Many such individuals are centrally obese. Here we evaluate whether the trial outcomes varied by the level of central obesity. RESEARCH DESIGN AND METHODS - The cohort included 4,687 people (47.7% women) with DM and hypertension. Mean age was 62.2, and mean follow-up was 4.7 years. Participants were randomly assigned to one of two blood pressure treatment strategies: intensive (systolic, < 120mmHg) or standard (systolic < 140mmHg). Sex-specific quartiles of waist-to-height ratio were used as themeasure of central obesity.The primary ACCORDoutcome (a composite of nonfatal myocardial infarction [MI], nonfatal stroke, or CVD death) and three secondary outcomes (nonfatal MI, fatal or nonfatal stroke, and CVD death) were examined using proportional hazard models. RESULTS - There was no evidence that the effect of intensively lowering blood pressure differed by quartile of waist-to-height ratio for any of the four outcomes (P > 0.25 in all cases). Controlling for waist-to-height quartile had no significant impact on previously published results for intensive blood pressure therapy. Waist-to-height ratio was significantly related to CVD mortality (hazard ratio 2.32 [95% CI 1.40-3.83], P = 0.0009 comparing the heaviest to lightest quartiles), but not to the other outcomes (P > 0.09 in all cases). CONCLUSIONS - Intensive lowering of blood pressure versus standard treatment does not ameliorate CVD risk in individuals with DM and hypertension. These results did not vary by quartile of waist-to-height ratio.