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 factorsSBP target: <120 mmHg
Achieved (mean) SBP/DBP: 119.3/64.4 mmHg
SBP target: 130–140 mmHg
Achieved (mean) SBP/DBP: 13.5/70.5 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 (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 indapamide
Achieved (mean) SBP/DBP: 136/73 mmHg
Control: placebo
Achieved (mean) SBP/DBP: 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 (174)
HOT (185)18,790 participants, including 1,501 with diabetesDBP target: ≤80 mmHgDBP target: ≤90 mmHg• In the overall trial, there was no cardiovascular benefit with more intensive targets
• In the subpopulation with diabetes, an intensive DBP target was associated with a significantly reduced risk (51%) of CVD events
SPRINT (39)9,361 participants without diabetesSBP target: <120 mmHg
Achieved (mean): 121.4 mmHg
SBP target: <140 mmHg
Achieved (mean): 136.2 mmHg
• Intensive SBP target lowered risk of the primary composite outcome 25% (MI, ACS, stroke, heart failure, and death due to CVD)
• Intensive target reduced risk of death 27%
• Intensive therapy increased risks of electrolyte abnormalities and AKI
  • ACCORD BP, Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial; ACS, acute coronary syndrome; ADVANCE BP, Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation–Blood Pressure trial; AKI, acute kidney injury; CVD, cardiovascular disease; DBP, diastolic blood pressure; HOT, Hypertension Optimal Treatment trial; MI, myocardial infarction; SBP, systolic blood pressure; SPRINT, Systolic Blood Pressure Intervention Trial; T2D, type 2 diabetes. Data from this table can also be found in the ADA position statement “Diabetes and Hypertension” (17).