Effects of intensive blood pressure lowering in patients with diabetes: A pooled analysis of the STEP and ACCORD‐BP randomized trials
Pooled result · Modified primary composite outcomeResult — go to the resultHazard ratio 0.77 95% CI 0.64–0.93Authors' conclusion
An intensive SBP-lowering target of 110 to <130 mmHg reduces the cardiovascular outcomes compared with a standard SBP-lowering target of 130 to <150 mmHg. The findings of this study support the favourable effects of intensive SBP lowering in hypertensive patients with diabetes.
Study context
- Population
- Hypertensive patients with diabetes (STEP diabetes subgroup, n = 1627; ACCORD-BP standard glycaemic group, n = 2362)
- Participants
- 3,989 patients2 RCTs
- Comparison
- Intensive vs standard systolic blood pressure (SBP) target
- Intensiven = 1,984
- Standardn = 2,005reference
- Outcome
- Modified composite of:
- Stroke
- Major coronary artery disease (MI and unstable angina)
- HF
- Cardiovascular death
- Follow-up
- Median 3.83 years
Methodological detailsSTEP and ACCORD-BP, Cox proportional hazards regression, one-stage mixed-effect and two-stage sensitivity analyses
- STEP and ACCORD-BP
- Cox proportional hazards regression
- One-stage mixed-effect and two-stage sensitivity analyses
Pooled result
Modified primary composite outcome
Hazard ratio
0.77
95% CI 0.64–0.93
Events by group
Intensive
193 of 1984
events
Standard
247 of 2005
events
Intensivevs Standard
HR 0.77 (95% CI 0.64–0.93)
As reported in the abstract
Further pooled results
| Outcome | Intensive | Standard | HR (95% CI) | |
|---|---|---|---|---|
| Stroke | 32/1984 events | 58/2005 events | 0.56 (0.36–0.86) | |
| 0.20.5125Hazard ratio (log scale) |
Other secondary outcomes (other components of primary outcome, all-cause death)
- Incidence lower with intensive than standard but not significantly different
Sensitivity and supplementary analyses
- Results remained consistent
Original publication
Effects of intensive blood pressure lowering in patients with diabetes: A pooled analysis of the STEP and ACCORD‐BP randomized trials. Diabetes Obes Metab. Published 9 December 2022. doi:10.
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