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In Brief | Cardiovascular | Hypertension
Blood Pressure Targets in Type 2 Diabetes: Insights from the BPROAD Trial
Time to read: 02:31Time to listen: 05:56
Originally Published: November 2024
Source: NEJM
Type of article: In Brief
MedED Catalogue Reference: MNIB011
Category: Cardiovascular
Cross Reference: Hypertension
Keywords: hypertension, cardiovascular disease
Intensive systolic blood pressure control (<120 mm Hg) significantly reduced major cardiovascular disease events in patients with type 2 diabetes compared to standard treatment (<140 mm Hg), with consistent benefits across subgroups.
This article is a review of recent studies originally published in the NEJM, November 2024. This article does not represent the original research, nor is it intended to replace the original research. Access the full Disclaimer Information.
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Elevated systolic blood pressure is a common and modifiable risk factor for cardiovascular disease in patients with type 2 diabetes. While reducing blood pressure is known to lower cardiovascular risk, the optimal target remains unclear.
Previous trials, such as ACCORD, found no significant benefit in aggressively lowering systolic blood pressure to below 120 mm Hg, though study limitations may have influenced the results. In contrast, the SPRINT trial demonstrated cardiovascular benefits from intensive blood-pressure control, but this study excluded diabetic patients.
Recent subgroup analyses have produced further conflicting findings, leaving uncertainty about whether more intensive blood pressure reduction is beneficial for individuals with type 2 diabetes.
To address this gap, the Blood Pressure Control Target in Diabetes (BPROAD) trial was conducted.
Study Purpose
The study aimed to determine whether an intensive systolic blood pressure target of less than 120 mm Hg is more effective than the standard target of less than 140 mm Hg in reducing major cardiovascular events among patients with type 2 diabetes.
Clinical Trial Registration: NCT03808311
Study Methodology
Participants were randomly assigned to receive intensive treatment targeting a systolic blood pressure (SBP) of less than 120 mmHg or standard treatment targeting an SBP of less than 140 mmHg.
Patients were followed up for up to five years.
The primary outcome was a composite of nonfatal stroke, nonfatal myocardial infarction, heart failure requiring treatment or hospitalization, and cardiovascular-related death.
Findings
The BPROAD trial enrolled 12,821 patients, with 45.3% women and a mean age of 63.8 years.
At one year, mean systolic blood pressure was 121.6 mm Hg in the intensive-treatment group and 133.2 mm Hg in the standard-treatment group.
Over a median follow-up of 4.2 years, the primary outcome occurred in 1.65 per 100 person-years in the intensive group versus 2.09 per 100 person-years in the standard group (HR, 0.79; 95% CI, 0.69–0.90; P<0.001).
Serious adverse events were similar between groups, but symptomatic hypotension and hyperkalemia were more common in the intensive-treatment group.
This trial demonstrated that intensive systolic blood pressure control (<120 mm Hg) significantly reduced major cardiovascular disease events in patients with type 2 diabetes compared to standard treatment (<140 mm Hg).
These benefits were consistent across all subgroups. Unlike the ACCORD trial, which found no significant difference, BPROAD had a larger sample size and higher statistical power, strengthening its findings.
The results align with the SPRINT and ESPRIT trials, supporting more aggressive blood pressure management. Intensive treatment lowers stroke incidence, highlighting its potential impact, particularly in populations with high stroke risk, such as China.
Despite these benefits, intensive treatment increased symptomatic hypotension and hyperkalemia, necessitating careful monitoring. Limitations include treatment awareness among patients and physicians, reliance on telephone interviews during COVID-19, and generalizability concerns.
Overall, the findings support more intensive systolic blood pressure control in diabetes management, with appropriate risk monitoring for adverse events.
Conclusion
With its large sample size and rigorous methodology, the BPROAD trial provides crucial evidence on optimal blood pressure targets for patients with type 2 diabetes. The findings help clarify treatment strategies and inform future guidelines on cardiovascular risk reduction in this high-risk population.
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