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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EIntensive blood pressure control did not reduce the rate of a composite outcome of major cardiovascular events in high-risk patients with type 2 diabetes mellitus, according to the Action to Control Cardiovascular Risk in Diabetes [ACCORD; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00000620\u0026amp;atom=%2Fspmdc%2F10%2F2%2F12.1.atom\u0022\u003ENCT00000620\u003C\/a\u003E] Blood Pressure Trial.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eprevention \u0026amp; screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ediabetes mellitus clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ehypertensive disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EIntensive blood pressure (BP) control did not reduce the rate of a composite outcome of major cardiovascular (CV) events in high-risk patients with type 2 diabetes mellitus (DM), according to the Action to Control Cardiovascular Risk in Diabetes (ACCORD; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00000620\u0026amp;atom=%2Fspmdc%2F10%2F2%2F12.1.atom\u0022\u003ENCT00000620\u003C\/a\u003E) Blood Pressure Trial. William C. Cushman, MD, VA Medical Center, Memphis, TN, presented the results of the ACCORD BP Trial.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EThe ACCORD BP Trial included 4733 patients with stable type 2 DM \u0026gt; 3 months (average duration 10 years), with hemoglobin A1c 7.5% to 11%, who were considered to be at high risk for CVD (defined as clinical or subclinical disease or \u2265 2 CV risk factors, in addition to DM). Patients were randomized to receive either intensive therapy (n=2362) (initial 2-drug therapy of thiazide-type diuretic plus an angiotensin-converting enzyme inhibitor (ACEI), an angiotensin receptor blocker (ARB), or a \u03b2-blocker was recommended with drugs added or titrated at each visit in order to achieve a systolic BP (SBP) of \u0026lt;120 mmHg) or standard therapy (n=2371) (where therapy was intensified if SBP was \u2265160 mmHg at one visit or \u2265140 mmHg during two consecutive visits; therapy was down-titrated if SBP was \u0026lt;130 mmHg at one visit or \u0026lt;135 mmHg during two consecutive visits). The target SBP for the intensive therapy group was \u0026lt;120 mmHg, and the target SBP in the standard therapy group was \u0026lt;140 mmHg.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThe primary outcome was the first occurrence of a major CV event (defined as nonfatal myocardial infarction [MI], nonfatal stroke, or CV death). Secondary outcomes included an expanded macrovascular outcome (defined as a combination of the primary outcome plus revascularization or hospitalization for congestive heart failure), major coronary disease events (defined as a combination of a fatal coronary event, a nonfatal MI, or unstable angina), hospitalization or death due to heart failure, all stroke, death from any cause, or death from CV causes.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe rate of serious adverse events, although infrequent, was significantly higher in those who were treated with intensive therapy compared with those who received standard therapy (3.3% vs 1.3%, respectively; p\u0026lt;0.001). Additionally, the mean estimated glomerular filtration rates were significantly lower in the intensive therapy group (75 vs 81mL\/min\/1.73m\u003Csup\u003E2\u003C\/sup\u003E; p\u0026lt;0.001), but the incidence of end-stage renal disease was no different. One year from study end, the mean SBP averaged 119.3 mmHg versus 133.5 mm Hg for intensive and standard groups, respectively, which amounted to a difference of 14.2 mmHg.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EThe annual rate of the composite of fatal and nonfatal CV events was similar in both groups (1.87% vs 2.09% per year for standard therapy; p=0.20). There was no difference in death from any cause between the two groups. Interestingly, the prespecified secondary outcomes of total stroke (p=0.01) and nonfatal stroke (p=0.03) were lower in the intensive therapy group. No interaction within predefined subgroups was found, although there was a trend (p\u0026lt;0.08) for modification of effect by randomization to intensive or standard glycemia intervention, with benefit in the standard group.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EThese results failed to demonstrate that lower target SBP (\u0026lt;120 mmHg), through the use of intensive therapy, reduces the rate of fatal and nonfatal CV events (composite primary endpoint) in high-risk patients with type 2 DM.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2010 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section ref-list\u0022 id=\u0022ref-list-1\u0022\u003E\u003Ch2 class=\u0022\u0022\u003EFurther Reading\u003C\/h2\u003E\u003Col class=\u0022cit-list ref-use-labels\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label ref-label-empty\u0022\u003E\u003C\/span\u003E\n            \u003Cdiv class=\u0022cit ref-cit ref-journal no-rev-xref\u0022 id=\u0022cit-10.2.12-a.1\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Ccite\u003E\u003Cspan class=\u0022cit-article-title\u0022\u003EThe ACCORD Study Group\u003C\/span\u003E \n               \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003E\n                  N Engl J Med\n               \u003C\/abbr\u003E \n               \u003Cspan class=\u0022cit-pub-date\u0022\u003E2010\u003C\/span\u003E; published online ahead of print.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003C\/li\u003E\u003C\/ol\u003E\u003C\/div\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/10\/2\/12.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmt61\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}