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, .
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.
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.
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