Effect of Intensive Versus Standard Blood Pressure Control on Depression and Health-Related Quality of Life in Type 2 Diabetes
The ACCORD trial
- Patrick J. O’Connor, MD, MA, MPH1⇓,
- K.M. Venkat Narayan, MD2,
- Roger Anderson, PHD3,
- Patricia Feeney, MA, MS4,
- Larry Fine, MD5,
- Mohammed K. Ali, MBCHB, MSC2,
- Debra L. Simmons, MD, MS6,
- Don G. Hire, BS4,
- JoAnn M. Sperl-Hillen, MD1,
- Lois Anne Katz, MD7,
- Karen L. Margolis, MD, MPH1 and
- Mark D. Sullivan, MD, PHD8
- 1HealthPartners Research Foundation, Minneapolis, Minnesota
- 2Hubert Department of Global Health, Emory University, Atlanta, Georgia
- 3Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
- 4Wake Forest University Health Sciences, Winston Salem, North Carolina
- 5National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
- 6Central Arkansas Veterans Healthcare System, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- 7VA New York Harbor Healthcare System, New York, New York
- 8Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
- Corresponding author: Patrick J. O’Connor, patrick.j.oconnor{at}healthpartners.com.
Abstract
OBJECTIVE We tested the hypothesis that intensive (systolic blood pressure [SBP] <120 mmHg) rather than standard (SBP 130–139 mmHg) blood pressure (BP) control improves health-related quality of life (HRQL) in those with type 2 diabetes.
RESEARCH DESIGN AND METHODS Subjects were 1,028 ACCORD (Action to Control Cardiovascular Risk in Diabetes) BP trial HRQL substudy participants who completed baseline and one or more 12-, 36-, or 48-month HRQL evaluations. Multivariable linear regression assessed impact of BP treatment assignment on change in HRQL.
RESULTS Over 4.0 years of follow-up, no significant differences occurred in five of six HRQL measures. Those assigned to intensive (vs. standard) BP control had statistically significant worsening of the Medical Outcomes Study 36-item short-form health survey (SF36) physical component scores (−0.8 vs. −0.2; P = 0.02), but magnitude of change was not clinically significant. Findings persisted across all prespecified subgroups.
CONCLUSIONS Intensive BP control in the ACCORD trial did not have a clinically significant impact, either positive or negative, on depression or patient-reported HRQL.
Footnotes
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The opinions and interpretations expressed in this article do not necessarily reflect those of the study’s sponsors or funding agencies.
- Received September 27, 2011.
- Accepted March 8, 2012.
- © 2012 by the American Diabetes Association.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
