Table 10.1

Randomized controlled trials of intensive versus standard hypertension treatment strategies

Clinical trialPopulationIntensiveStandardOutcomes
ACCORD BP (28)4,733 participants with T2D aged 40–79 years with prior evidence of CVD or multiple cardiovascular risk factorsSystolic blood pressure target: <120 mmHgSystolic blood pressure target: 130–140 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
Achieved (mean) systolic/diastolic: 119.3/64.4 mmHgAchieved (mean) systolic/diastolic: 133.5/70.5 mmHg
ADVANCE BP (29)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 indapamideControl: placebo• 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 (174)
Achieved (mean) systolic/diastolic: 136/73 mmHgAchieved (mean) systolic/diastolic: 141.6/75.2 mmHg
HOT (173)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 (39)9,361 participants without diabetesSystolic blood pressure target: <120 mmHgSystolic blood pressure target: <140 mmHg• Intensive systolic blood pressure target lowered risk of the primary composite outcome 25% (MI, ACS, stroke, HF, and death due to CVD)
• Intensive target reduced risk of death 27%
• Intensive therapy increased risks of electrolyte abnormalities and AKI
Achieved (mean): 121.4 mmHgAchieved (mean): 136.2 mmHg
  • ACS, acute coronary syndrome; AKI, acute kidney injury; CVD, cardiovascular disease; HF, heart failure; MI, myocardial infarction; T2D, type 2 diabetes. Data from this table can also be found in the ADA position statement Diabetes and Hypertension” (17).