Rationale and Design for the Blood Pressure Intervention of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial

Cushman, William C.; Grimm, Richard H.; Cutler, Jeffrey A.; Evans, Gregory W.; Capes, Sarah E.; Corson, Marshall A.; Sadler, Laurie S.; Alderman, Michael H.; Peterson, Kevin; Bertoni, Alain G.; Basile, Jan

doi:10.1016/j.amjcard.2007.03.005

Cited by 119 publications

(68 citation statements)

References 29 publications

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“…Moreover, in Action to Control Cardiovascular Risk in Diabetes (ACCORD), intensive control of BP among patients with type 2 diabetes failed to reduce the annual rate of the primary outcome, a composite of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. 34 …”

Section: Age Bp and Mortalitymentioning

confidence: 99%

Age, Race, Diabetes, Blood Pressure, and Mortality among Hemodialysis Patients

Myers¹,

Adams²,

Rohrscheib³

et al. 2010

Journal of the American Society of Nephrology

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Observational studies involving hemodialysis patients suggest a U-shaped relationship between BP and mortality, but the majority of these studies followed large, heterogeneous cohorts. To examine whether age, race, and diabetes status affect the association between systolic BP (SBP; predialysis) and mortality, we studied a cohort of 16,283 incident hemodialysis patients. We constructed a series of multivariate proportional hazards models, adding age and BP to the analyses as cubic polynomial splines to model potential nonlinear relationships with mortality. Overall, low SBP associated with increased mortality, and the association was more pronounced among older patients and those with diabetes. Higher SBP associated with increased mortality among younger patients, regardless of race or diabetes status. We observed a survival advantage for black patients primarily among older patients. Diabetes associated with increased mortality mainly among older patients with low BP. In conclusion, the design of randomized clinical trials to identify optimal BP targets for patients with ESRD should take age and diabetes status into consideration.

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Section: Age Bp and Mortalitymentioning

confidence: 99%

Age, Race, Diabetes, Blood Pressure, and Mortality among Hemodialysis Patients

Myers¹,

Adams²,

Rohrscheib³

et al. 2010

Journal of the American Society of Nephrology

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“…One is the National Institutes of Health (NIH)-sponsored Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial [23]. The glycemic control component of ACCORD was stopped in February 2008, but the BP component [24] is continuing. This is an unmasked, open-label trial with over 4700 participants randomized to an SBP goal of less than 140 mmHg or less than 120 mmHg.…”

Section: Clinical Trials With Hard Endpointsmentioning

confidence: 99%

Evidence for a lower target blood pressure for people with heart disease

Rosendorff

Black

2009

Current Opinion in Cardiology

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“…AC-CORD BP was a randomized, nonblinded study that tested the effect of an intensive reduction of SBP to less than 120 mmHg in 4,733 patients with type 2 diabetes who had a baseline SBP between 130 and 180 mmHg, whether treated for hypertension (with one to three antihypertensive medications) or not. Participants were randomly assigned to intensive therapy with an SBP target of less than 120 mm Hg or standard therapy that aimed at an SBP less than 140 mmHg [14,15]. All currently available antihypertensive drug classes could be (and were) used in the two groups.…”

Section: Hypertensive Patients With Type 2 Diabetes Mellitusmentioning

confidence: 99%

Establishing Targets for Hypertension Control in Patients with Comorbidities

Feldstein

Julius

2010

Curr Hypertens Rep

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Most current guidelines recommend tighter blood pressure (BP) control in hypertensive patients with comorbidities. These recommendations are based on epidemiologic data indicating that cardiovascular risk increases at lower BP levels in hypertensive patients with comorbidities than in those without comorbidities. Hypertension guidelines usually reflect outcomes from previous studies, but current recommendations for patients with comorbidities have preceded the evidence. We review recent studies investigating whether these new targets can be achieved, whether they are well tolerated, and whether they positively affect the outcomes. The results of the few current studies about outcomes in lower BP target groups are either negative or somewhat--but not decidedly--positive. There is a need for new trials designed to evaluate the validity of current recommendations for tighter BP control in hypertensive patients with comorbidities. Additionally, existing data from published trials could be reanalyzed to provide further clarification.

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Rationale and Design for the Blood Pressure Intervention of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial

Cited by 119 publications

References 29 publications

Age, Race, Diabetes, Blood Pressure, and Mortality among Hemodialysis Patients

Age, Race, Diabetes, Blood Pressure, and Mortality among Hemodialysis Patients

Evidence for a lower target blood pressure for people with heart disease

Establishing Targets for Hypertension Control in Patients with Comorbidities

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