Table 2

Randomized controlled trials of intensive vs. standard hypertension treatment strategies

Clinical trialPopulationIntensiveStandardOutcomes
ACCORD BP (18)4,733 participants with T2D aged 40–79 years with prior evidence of CVD or multiple cardiovascular risk factorsSystolic blood pressure target: <120 mmHg
Achieved (mean) systolic/diastolic: 119.3/64.4 mmHg
Systolic blood pressure target: 130–140 mmHg
Achieved (mean) systolic/diastolic: 133.5/70.5 mmHg
  • No benefit in primary end point: composite of nonfatal MI, nonfatal stroke, and CVD death

  • Stroke risk reduced 41% with intensive control, not sustained through follow-up beyond the period of active treatment

  • Adverse events more common in intensive group, particularly elevated serum creatinine and electrolyte abnormalities

ADVANCE BP (43)11,140 participants with T2D aged 55 years and older with prior evidence of CVD or multiple cardiovascular risk factorsIntervention: a single-pill, fixed-dose combination of perindopril and indapamide
Achieved (mean) systolic/diastolic: 136/73 mmHg
Control: placebo
Achieved (mean) systolic/diastolic: 141.6/75.2 mmHg
  • Intervention reduced risk of primary composite end point of major macrovascular and microvascular events (9%), death from any cause (14%), and death from CVD (18%)

  • 6-year observational follow-up found reduction in risk of death in intervention group attenuated but still significant (134)

HOT (135)18,790 participants, including 1,501 with diabetesDiastolic blood pressure target: ≤80 mmHgDiastolic blood pressure target: ≤90 mmHg
  • In the overall trial, there was no cardiovascular benefit with more intensive targets

  • In the subpopulation with diabetes, an intensive diastolic target was associated with a significantly reduced risk (51%) of CVD events

SPRINT (19)9,361 participants without diabetesSystolic blood pressure target: <120 mmHg
Achieved (mean): 121.4 mmHg
Systolic blood pressure target: <140 mmHg
Achieved (mean): 136.2 mmHg
  • Intensive systolic blood pressure target lowered risk of the primary composite outcome 25% (MI, acute coronary syndrome, stroke, heart failure, and death due to CVD)

  • Intensive target reduced risk of death 27%

  • Intensive therapy increased risks of electrolyte abnormalities and acute kidney injury

  • CVD, cardiovascular disease; T2D, type 2 diabetes.