Intensive Blood Pressure Control in Patients With Diabetes and Previous Stroke: A Post‐Hoc Analysis of ACCORD‐BP Trial
ABSTRACT Intensive systolic blood pressure (SBP) control reduces cardiovascular outcomes in hypertensive patients, but its effects in those with diabetes and prior stroke need further evidence. Among 4733 patients with elevated SBP enrolled in the ACCORD‐BP (Action to Control Cardiovascular Risk in...
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| Format: | Article |
| Language: | English |
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Wiley
2025-07-01
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| Series: | The Journal of Clinical Hypertension |
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| Online Access: | https://doi.org/10.1111/jch.70095 |
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| author | Zhixian Wang Jue Wang Liu He Chao Jiang Yufeng Wang Ting Shen Meiqi Zhao Enze Li Ning Zhou Caihua Sang Xin Du Jianzeng Dong Changsheng Ma |
| author_facet | Zhixian Wang Jue Wang Liu He Chao Jiang Yufeng Wang Ting Shen Meiqi Zhao Enze Li Ning Zhou Caihua Sang Xin Du Jianzeng Dong Changsheng Ma |
| author_sort | Zhixian Wang |
| collection | DOAJ |
| description | ABSTRACT Intensive systolic blood pressure (SBP) control reduces cardiovascular outcomes in hypertensive patients, but its effects in those with diabetes and prior stroke need further evidence. Among 4733 patients with elevated SBP enrolled in the ACCORD‐BP (Action to Control Cardiovascular Risk in Diabetes–Blood Pressure) trial, this post‐hoc analysis focused on 307 patients with type 2 diabetes and prior stroke to evaluate intensive versus standard SBP control. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. Inverse probability of treatment weighting (IPTW)‐adjusted Kaplan‐Meier and Cox regression analyses were performed with a 3‐year conditional landmark. Multivariable Cox regression models and overlap weighting models were constructed in sensitivity analysis. In landmark analysis at the 3‐year time point, intensive SBP control was associated with a significantly lower risk of MACE (hazard ratio [HR] 0.55, 95% CI, 0.32–0.95) using the IPTW Cox model. The associations remained consistent across multivariable Cox regression model (HR 0.53, 95% CI, 0.31–0.90) and overlap weighting model (HR 0.55, 95% CI, 0.32–0.94). Patients in the intensive SBP control group showed a trend toward lower recurrent stroke risk, though it was not statistically significant (HR 0.65, 95% CI, 0.30–1.37). Similar trends were observed in subgroup analyses. In conclusion, targeting an SBP below 120 mmHg in patients with diabetes and prior stroke is associated with a lower risk of major cardiovascular events without increasing the risk of recurrent stroke. Trial Registration: ClinicalTrials.gov identifier: NCT00000620 |
| format | Article |
| id | doaj-art-538c523d2baa4dc09976bd79a3a09b92 |
| institution | Kabale University |
| issn | 1524-6175 1751-7176 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | The Journal of Clinical Hypertension |
| spelling | doaj-art-538c523d2baa4dc09976bd79a3a09b922025-08-20T03:55:49ZengWileyThe Journal of Clinical Hypertension1524-61751751-71762025-07-01277n/an/a10.1111/jch.70095Intensive Blood Pressure Control in Patients With Diabetes and Previous Stroke: A Post‐Hoc Analysis of ACCORD‐BP TrialZhixian Wang0Jue Wang1Liu He2Chao Jiang3Yufeng Wang4Ting Shen5Meiqi Zhao6Enze Li7Ning Zhou8Caihua Sang9Xin Du10Jianzeng Dong11Changsheng Ma12Department of Cardiology Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology Beijing Anzhen Hospital Capital Medical University and National Clinical Research Center for Cardiovascular Diseases Beijing ChinaABSTRACT Intensive systolic blood pressure (SBP) control reduces cardiovascular outcomes in hypertensive patients, but its effects in those with diabetes and prior stroke need further evidence. Among 4733 patients with elevated SBP enrolled in the ACCORD‐BP (Action to Control Cardiovascular Risk in Diabetes–Blood Pressure) trial, this post‐hoc analysis focused on 307 patients with type 2 diabetes and prior stroke to evaluate intensive versus standard SBP control. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. Inverse probability of treatment weighting (IPTW)‐adjusted Kaplan‐Meier and Cox regression analyses were performed with a 3‐year conditional landmark. Multivariable Cox regression models and overlap weighting models were constructed in sensitivity analysis. In landmark analysis at the 3‐year time point, intensive SBP control was associated with a significantly lower risk of MACE (hazard ratio [HR] 0.55, 95% CI, 0.32–0.95) using the IPTW Cox model. The associations remained consistent across multivariable Cox regression model (HR 0.53, 95% CI, 0.31–0.90) and overlap weighting model (HR 0.55, 95% CI, 0.32–0.94). Patients in the intensive SBP control group showed a trend toward lower recurrent stroke risk, though it was not statistically significant (HR 0.65, 95% CI, 0.30–1.37). Similar trends were observed in subgroup analyses. In conclusion, targeting an SBP below 120 mmHg in patients with diabetes and prior stroke is associated with a lower risk of major cardiovascular events without increasing the risk of recurrent stroke. Trial Registration: ClinicalTrials.gov identifier: NCT00000620https://doi.org/10.1111/jch.70095blood pressurecardiovascular outcomediabetes mellitushypertensionstroke |
| spellingShingle | Zhixian Wang Jue Wang Liu He Chao Jiang Yufeng Wang Ting Shen Meiqi Zhao Enze Li Ning Zhou Caihua Sang Xin Du Jianzeng Dong Changsheng Ma Intensive Blood Pressure Control in Patients With Diabetes and Previous Stroke: A Post‐Hoc Analysis of ACCORD‐BP Trial The Journal of Clinical Hypertension blood pressure cardiovascular outcome diabetes mellitus hypertension stroke |
| title | Intensive Blood Pressure Control in Patients With Diabetes and Previous Stroke: A Post‐Hoc Analysis of ACCORD‐BP Trial |
| title_full | Intensive Blood Pressure Control in Patients With Diabetes and Previous Stroke: A Post‐Hoc Analysis of ACCORD‐BP Trial |
| title_fullStr | Intensive Blood Pressure Control in Patients With Diabetes and Previous Stroke: A Post‐Hoc Analysis of ACCORD‐BP Trial |
| title_full_unstemmed | Intensive Blood Pressure Control in Patients With Diabetes and Previous Stroke: A Post‐Hoc Analysis of ACCORD‐BP Trial |
| title_short | Intensive Blood Pressure Control in Patients With Diabetes and Previous Stroke: A Post‐Hoc Analysis of ACCORD‐BP Trial |
| title_sort | intensive blood pressure control in patients with diabetes and previous stroke a post hoc analysis of accord bp trial |
| topic | blood pressure cardiovascular outcome diabetes mellitus hypertension stroke |
| url | https://doi.org/10.1111/jch.70095 |
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