No interactive effect of intensive blood pressure and glycemic control

The combination of intensive blood pressure (BP) control and intensive glycemic control doesn’t produce an additional benefit in preventing microvascular complications of type 2 diabetes, concludes a trial in Kidney International.

The researchers analyzed data from the randomized ACCORD-BP trial, including 4733 older adults with type 2 diabetes and hypertension. Patients were separately assigned to intensive or standard BP control (systolic BP target <120 mm Hg versus 140 mm Hg) and intensive or standard glycemic control (target HbA1c <6.0 percent versus 0.07–0.79 percent). Microvascular outcomes were assessed, including a composite of renal failure and retinopathy plus nine individual outcomes.

At a mean follow-up of 4.7 years, there were no significant differences in the composite outcome rates between groups: 11.4 versus 10.9 percent with intensive versus standard BP control, and 11.1 versus 11.2 percent with intensive versus standard glycemic control. The risk of microalbuminuria was lower with intensive BP control (hazard ratio 0.84). Intensive glycemic control was associated with a “near-significant” reduction in macroalbuminuria.

There was no evidence that the combination of intensive BP control and intensive glycemic control had any interactive effect. None of the study treatments were effective in preventing renal failure.

Previous trials have shown reductions in the risk of some microvascular complications of type 2 diabetes with intensive BP or glycemic control. The new ACCORD-BP results show a reduced risk of microalbuminuria in patients assigned to intensive BP control, but no effect on other microvascular end points. In the targeted group of older patients with established type 2 diabetes and hypertension, “additional benefit from simultaneous intensive management was not apparent,” the researchers conclude [Ismail-Beigi F, et al. Combined intensive blood pressure and glycemic control does not produce an additive benefit on microvascular outcomes in type 2 diabetic patients. Kidney Int 2012; 81:586–594].