Amid contrasting SPRINT and ACCORD findings, Shawna Nesbitt highlights significant benefits for nondiabetics.
CHICAGO, IL—A groundbreaking study, the BPROAD trial, indicates that intensively lowering systolic blood pressure to below 120 mm Hg can significantly decrease major cardiovascular event risks over four years for patients suffering from type 2 diabetes and hypertension, as opposed to the conventional target of less than 140 mm Hg.
The BPROAD trial’s findings resonate with those reported in the 2015 SPRINT trial, which initially examined non-diabetic patients and influenced the 2017 US hypertension guidelines that revised the target below 130/80 mm Hg. Moreover, recent European guidelines released in September also recommend lowering systolic blood pressure targets to under 130 mm Hg, reflecting a broader consensus on aggressive treatment approaches.
The results were concurrently published in the prestigious New England Journal of Medicine.
Interestingly, these findings stand in stark contrast to the 2010 ACCORD trial, which focused on diabetic patients and evaluated both lipid control and blood pressure reduction but did not demonstrate a significant difference in cardiovascular events attributable to blood pressure management.
“That made the blood pressure aspect of the study somewhat ambiguous,” said Shawna Nesbitt, MD from UT Southwestern Medical Center in Dallas, TX, during a media briefing with TCTMD. “This trial now offers confirmation that diabetics respond to blood pressure treatments similarly to nondiabetics.”
John McEvoy, MBBCh from the University of Galway, Ireland, co-chair of the ESC hypertension guidelines, expressed that he was “pleasantly surprised” by the BPROAD study’s results. “The ESC guidelines issued in August suggested treating diabetic patients to the same targets as individuals with heightened cardiovascular disease risk, so it was gratifying to see alignment with BPROAD’s outcomes.”
Intensive Lowering Wins
This extensive study included 12,821 participants from China, with a mean age of 63.8 years and 45.3% identifying as women. These patients all had type 2 diabetes, presenting with a systolic blood pressure of at least 140 mm Hg without medication or a minimum of 130 mm Hg while on one or more antihypertensive medications. The participants were defined as being at an elevated risk for cardiovascular disease based on either recent clinical events or the presence of multiple risk factors.
The findings highlight a randomized group of 6,414 patients who were assigned to an intensive blood pressure lowering strategy, aiming to enhance clinical outcomes dramatically.
Amit Khera emphasized the need to implement these crucial findings globally. “Now we have to work towards bringing these important insights to millions of individuals living with diabetes.”
In evaluating the adverse events across both study groups, the researchers found similar rates of serious complications at approximately 36%. However, a greater incidence of symptomatic hypotension and hyperkalemia was noted among participants who underwent intensive treatment, warranting careful clinical attention.
Remarkably, the occurrence of new cases of albuminuria was significantly lower in the intensive treatment group, reinforcing the benefits of aggressive hypertension management.
The research highlights the importance of rigorous systolic blood pressure control in diabetic patients to mitigate major cardiovascular disease events. However, it emphasizes close monitoring for adverse effects such as hypotension and elevated potassium levels during the initiation of intense blood pressure management.
Filling ‘a Key Gap’
BPROAD affirms the existing directives put forth in current guidelines regarding tight blood pressure management.
“While we celebrate the findings that indicate blood pressure reduction leads to fewer events, we must also remain cognizant of the serious adverse effects arising from these changes, especially in older populations,” Nesbitt cautioned.
She also pointed out that while the intensive blood pressure results from both SPRINT and BPROAD appear consistent, it is crucial to note that SPRINT had a more diverse patient demographic, unlike the study sample in BPROAD.
Ultimately, “the evidence consistently shows that achieving blood pressure levels below 120 mm Hg is correlated with improved outcomes,” Nesbitt concluded.
There is no compelling biological rationale for why diabetics would respond differently to blood pressure treatment compared to others with risk factors for cardiovascular disease, according to John McEvoy.
“The ACCORD trial represented an anomaly and was inconsistent with a broader spectrum of research findings,” McEvoy asserted, highlighting that BPROAD holds distinct advantages over ACCORD given its larger sample size and comprehensive focus on heart failure outcomes within its primary endpoints.
The increase in incidents of hypotension and hyperkalemia associated with an intensified treatment approach should be duly monitored, yet these risks do not outweigh the anticipated cardiovascular benefits,” he explained, noting that most patients would prefer to avert the dangers of stroke and mortality compared to manageable risks of hypotension and hyperkalemia.
Amit Khera, MD from UT Southwestern Medical Center, confirmed that the BPROAD study significantly bridges important knowledge gaps concerning lower blood pressure, especially in diabetic patient populations. “The affirmative response is clear. We must focus on translating these critical findings into practice for millions of individuals with diabetes globally.”
Amidst Discrepant SPRINT and ACCORD Data, This Study Confirms the Benefits Seen in Nondiabetics
Ah, blood pressure! The thing we’re told to keep low, like our chances of winning the lottery. And just when you thought you had it figured out, along comes the BPROAD trial, casually reminding us that managing blood pressure – specifically systolic pressure below 120 mm Hg – can reduce those pesky cardiovascular events in type 2 diabetes patients. Seems like a bit of an overachiever to me, but let’s dig into the details!
These findings are all the rage among the medical community. They align nicely with what we saw in the 2015 SPRINT trial, minus the diabetics. The SPRINT trial had doctors raising their eyebrows and lowering targets with the 2017 US hypertension guidelines. Meanwhile, the Europeans also decided to jump on the bandwagon with their guidelines published just last month. Apparently, everyone wants to get in on the “lower is better” trend. I mean, who doesn’t want a little more chaos in their lives?
The BPROAD study appeared in the New England Journal of Medicine—so you know it’s serious. It didn’t shy away from contrasting itself with the 2010 ACCORD trial, which actually had diabetic patients in the mix, but was as clear as mud when it came to blood pressure outcomes. And of course, Shawna Nesbitt, MD, strolled in to confirm that diabetics respond to blood pressure treatment just like nondiabetics. Shocking, I know – science pulls out its trump card!
“Now we have to work towards implementing these important findings into millions of individuals worldwide with diabetes.” – Amit Khera
BPROAD wasn’t messing around, enrolling over 12,000 patients. And boy, did they aim for a target! With included heart failure outcomes, this study was practically overachieving while ACCORD struggled to hit the bullseye. I suppose some trials just want to follow the rules, while others worry about stroke rates and overall survival. It’s the classic tortoise and hare scenario, but in lab coats!
While serious adverse events seemed to party equally in both cohorts (about 36% – oh, what a lively affair!), those on the intensive treatment plan did have their share of troubles. Symptomatic hypotension and hyperkalemia—a fantastic duo that’ll keep your cardiologist on their toes. It’s like a deadly game of Whack-a-Mole, where you knock down one health issue only for another one to pop up. “Cheers to progress!” we say, while sipping our low-sodium cocktails.
And while we acknowledge that intensive treatments bring benefits, we’re also reminded to keep an eye out for those who have a penchant for hypotension and higher potassium levels. The fine print, folks! It’s what separates the amateurs from the professionals. What’s more, the BPROAD trial confirmed that the way to health might just lie in keeping your blood pressure below 120. Who would’ve thought? You’d be better off with a low-pressure policy than a high one.
“There’s no biological plausibility as to why diabetics would differ from others.” – John McEvoy
According to McEvoy – less drama, more consistency. With BPROAD all but echoing the results of SPRINT, he emphasized the discrepancy of ACCORD and held a pretty strong stance too! It’s worth mentioning, though, that BPROAD’s immense size and detailed endpoints make it a more robust study. Got to love it when trial sizes go big or go home!
In the grand scheme of things, we’re left standing at the crossroads of hypertension management with plenty of data in our pockets and recommendations that might reel us in. So remember, folks, with great blood pressure comes great responsibility—let’s not drop the ball on those key findings and get it right for our diabetic friends. They already have enough on their plates—we don’t need to add hypotension on top of that!
So, take your medicine, stay monitored, and keep the stroke at bay. If there’s a punchline in all this, it’s that lowering blood pressure can indeed pave the road to better cardiovascular health, with a side of caution, of course. After all, who wouldn’t want a little more life in their years?
How does intensive blood pressure management impact kidney outcomes in diabetic individuals?
Tail!
However, the researchers made it clear that the benefits from rigorous blood pressure management, especially reaching those levels below 120 mm Hg, notably outweigh the risks. With a lower incidence of new albuminuria cases in the intensive treatment group, it seems that strict hypertension management is a step in the right direction for diabetic patients. Talk about hitting two birds with one stone—less hypertension and improved kidney outcomes! Who knew managing blood pressure could be such a multifaceted endeavor?
As we celebrate these results, it’s essential to keep a close watch on patients undergoing intensive treatment, particularly for those older adults who might feel the ramifications of low blood pressure more acutely. It’s a bit of a balancing act, but according to McEvoy, it’s nothing we can’t handle. After all, he points out that most people would choose to dodge the life-threatening risks associated with strokes rather than worry too much about the potential side effects of medication. Priorities, right?
So, while BPROAD stands tall among its predecessors like SPRINT, it also challenges slight discrepancies with ACCORD, reinforcing our understanding of blood pressure management in diabetic patients. The medical community is on the verge of a major shift, urging us to rethink strategies and embrace the findings from these significant trials. As we look to the future, the call to action is clear: it’s time to take these valuable insights and make a difference for millions living with diabetes worldwide.
Final Thoughts
In the grand tapestry of scientific research on hypertension and diabetes, BPROAD has woven another thread, adding depth and clarity to our understanding. While the medical world gathers to implement these findings, what’s crystal clear is that patient outcomes improve with better blood pressure control—whether diabetic or not. Here’s to hoping this trial nudges the pendulum toward more comprehensive and effective patient care. Now, let’s roll up our sleeves and get to work!
