Longer time in BP target protects against adverse cardiovascular events in diabetes

For patients with hypertension and diabetes, longer time spent in blood pressure (BP) target range helps lower the risk of cardiovascular disease according to a study.

Researchers conducted a post hoc analysis of the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial to examine the effect of time in target range and other BP metrics in relation to clinical outcomes.

Time in range for each participant was calculated using linear interpolation and a systolic BP target range of 110–130 mm Hg. Cox models were applied to assess the prognostic value of time in target range and validate it with common BP metrics among patients with type 2 diabetes mellitus.

Results showed that a time in target range of 61.9–100.0 percent was associated with a 46-percent reduction in the risk of major adverse cardiovascular events (MACE; hazard ratio [HR], 0.54, 95 percent confidence interval [CI], 0.43–0.67) relative to a time in target range of 0–22.9 percent.

The associations were consistent for stroke (HR, 0.19, 95 percent CI, 0.10–0.36), myocardial infarction (HR, 0.67, 95 percent CI, 0.51–0.89), heart failure (HR, 0.47, 95 percent CI, 0.33–0.66), cardiovascular death (HR, 0.63, 95 percent CI, 0.42–0.93), and all-cause mortality (HR, 0.70, 95 percent CI, 0.54–0.91).

On further analyses, a curvilinear association between time in target range and MACE emerged, and this was independent of baseline, final, and mean systolic BP as well as visit-to-visit systolic BP variability.

The findings suggest that longer time in target BP rate may add value as an outcome measure for hypertension control studies among patients with diabetes.