New Trial Backs Intensive Blood Pressure Target for Adults with T2D: Daily Dose

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On November 18, 2024, we reported on findings from the BPROAD clinical trial presented at the American Heart Association (AHA) Scientific Sessions 2024.

The study

The BPROAD study was conducted to determine effective blood pressure (BP) targets in adults with type 2 diabetes (T2D) in the wake of previous studies, ie, ACCORD BP and SPRINT, which have generated conflicting results. From February 2019 through December 2021, researchers enrolled a cohort of 12 821 adults (mean age, 64 years; 45% women) from 145 sites in China, all of whom had elevated systolic blood pressure (SBP), T2D, and an increased risk of cardiovascular disease. Per study protocol, the criteria for elevated SBP was 140 mm Hg or greater untreated with antihypertensive medications or 130 mm Hg or greater while taking 1 or more antihypertensive medication.

Participants were randomly assigned to receive either intensive treatment to reduce SBP to less than 120 mm Hg (n = 6414) or standard treatment targeting an SBP of less than 140 mm Hg (n = 6407) for up to 5 years. The study’s primary outcome was a composite of nonfatal stroke, nonfatal myocardial infarction (MI), treatment or hospitalization for heart failure (HF), or CV death.

The findings

Over a median follow-up of 4.2 years, the composite outcome was observed in 393 participants (1.65% per year) in the intensive-treatment group and 492 participants (2.09% per year) in standard-treatment group, translating to 21% reduction in risk for MACE among the former group (HR, 0.79; 95% CI, 0.69 - 0.90; P < .001).

Authors' comment

"Future clinical practice guidelines will hopefully consider these results when making recommendations for blood pressure targets for people with type 2 diabetes. Beneficial future research could focus on profiling those with the largest benefit and the lowest harm in an intensive blood pressure treatment group.”

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