Generalizing Intensive Blood Pressure Treatment to Adults With Diabetes Mellitus

被引:10
作者
Berkowitz, Seth A. [1 ,2 ]
Sussman, Jeremy B. [3 ,4 ]
Jonas, Daniel E. [1 ,2 ]
Basu, Sanjay [5 ,6 ,7 ]
机构
[1] Univ N Carolina, Sch Med, Dept Med, Div Gen Med & Clin Epidemiol, Chapel Hill, NC 27515 USA
[2] Univ N Carolina, Cecil G Sheps Ctr Hlth Serv Res, Chapel Hill, NC 27515 USA
[3] Univ Michigan, Div Gen Med, Ann Arbor, MI 48109 USA
[4] Vet Affairs Ann Arbor Healthcare Syst, Ctr Clin Management Res, Ann Arbor, MI USA
[5] Stanford Univ, Ctr Primary Care & Outcomes Res, Ctr Populat Hlth Sci, Dept Med, Palo Alto, CA 94304 USA
[6] Stanford Univ, Ctr Primary Care & Outcomes Res, Ctr Populat Hlth Sci, Dept Hlth Res & Policy, Palo Alto, CA 94304 USA
[7] Harvard Med Sch, Ctr Primary Care, Boston, MA USA
基金
美国国家卫生研究院;
关键词
diabetes mellitus; generalizability; hypertension; transportability; ASSOCIATION TASK-FORCE; CARDIOVASCULAR RISK; HEART-ASSOCIATION; AMERICAN-COLLEGE; DISEASE; TRANSPORTABILITY; METAANALYSIS; PREVENTION; GUIDELINE; HBA(1C);
D O I
10.1016/j.jacc.2018.07.012
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND Controversy over blood pressure (BP) treatment targets for individuals with diabetes is in part due to conflicting perspectives about generalizability of available trial data. OBJECTIVE The authors sought to estimate how results from the largest clinical trial of intensive BP treatment among adults with diabetes would generalize to the U.S. population. METHODS The authors used transportability methods to reweight individual patient data from the ACCORD (Action to Control Cardiovascular Risk in Diabetes) BP trial (N = 4,507) of intensive (goal systolic BP <120 mm Hg) versus standard (goal systolic BP <140 mm Hg) treatment to better represent the demographic and clinical risk factors of the U.S. population of adults with diabetes (data from NHANES [National Health and Nutrition Examination Survey] 2005 to 2014, n = 1,943). The primary outcome was the first occurrence of nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. Analysis used weighted Cox proportional hazards regression models with robust standard errors. RESULTS The ACCORD BP sample had less racial/ethnic diversity and more elevated cardiovascular risk factors than the NHANES participants. Weighted results significantly favored intensive BP treatment, unlike unweighted results (hazard ratio for primary outcome in intensive versus standard treatment in weighted analyses: 0.67, 95% confidence interval: 0.49 to 0.91; in unweighted analyses: hazard ratio: 0.88, 95% confidence interval: 0.73 to 1.07). Over 5 years, the weighted results estimate a number needed to treat of 34, and number needed to harm of 55. CONCLUSIONS After reweighting to better reflect the U.S. adult population with diabetes, intensive BP therapy was associated with significantly lower risk for cardiovascular events. However, data were limited among racial/ethnic minorities and those with lower cardiovascular risk. (C) 2018 by the American College of Cardiology Foundation.
引用
收藏
页码:1214 / 1223
页数:10
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