No Significant Reduction in Major Cardiovascular Events with Intensive BP Lowering in T2D

In patients with type 2 diabetes (T2D) and high cardiovascular risk, targeting a systolic blood pressure (BP) of less than 120 mm Hg did not significantly reduce major cardiovascular events compared with a target of less than 140 mm Hg, according to a multicenter, open-label, randomized trial conducted in Brazil. A total of 9476 ethnically diverse patients (mean age, 64.7 years; 62.0% women) were assigned to intensive therapy (4745 patients) or standard therapy (4731 patients). During a median follow-up of 4.0 years, the mean systolic BP was 121.8 mm Hg in the intensive-therapy group and 135.4 mm Hg in the standard-therapy group. A primary-outcome event—a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina or heart failure—occurred in 286 patients (6.0%) in the intensive-therapy group and 315 patients (6.7%) in the standard-therapy group (hazard ratio, 0.90). Serious adverse events were similar between groups (14.9% vs. 14.6%). These findings suggest that more aggressive systolic BP targets do not confer significant additional cardiovascular benefit in this population. Source: https://www.nejm.org/