Systolic Blood Pressure Control Among Individuals With Type 2 Diabetes: A Comparative Effectiveness Analysis of Three Interventions

Abstract

Background: The relative effectiveness of 3 approaches to blood pressure control-(i) an intensive lifestyle intervention (ILI) focused on weight loss, (ii) frequent goal-based monitoring of blood pressure with pharmacological management, and (iii) education and support-has not been established among overweight and obese adults with type 2 diabetes who are appropriate for each intervention.

Methods: Participants from the Action for Health in Diabetes (Look AHEAD) and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) cohorts who met criteria for both clinical trials were identified. The proportions of these individuals with systolic blood pressure (SBP) <140 mm Hg from annual standardized assessments over time were compared with generalized estimating equations.

Results: Across 4 years among 480 Look AHEAD and 1,129 ACCORD participants with baseline SBPs between 130 and 159 mm Hg, ILI (OR = 1.46; 95% CI = [1.18-1.81]) and frequent goal-based monitoring with pharmacotherapy (OR = 1.51; 95% CI = [1.16-1.97]) yielded higher rates of blood pressure control compared to education and support. The intensive behavioral-based intervention may have been more effective among individuals with body mass index >30 kg/m2, while frequent goal-based monitoring with medication management may be more effective among individuals with lower body mass index (interaction P = 0.047).

Conclusions: Among overweight and obese adults with type 2 diabetes, both ILI and frequent goal-based monitoring with pharmacological management can be successful strategies for blood pressure control.

Clinical trials registry: clinicaltrials.gov identifiers NCT00017953 (Look AHEAD) and NCT00000620 (ACCORD).

Keywords: blood pressure; blood pressure control; blood pressure monitoring; comparative effectiveness; diabetes; hypertension; lifestyle intervention; obesity..

© American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Figures

Figure 1.

(a) Mean number of antihypertensive medication classes over time by intervention group. Classes are ACE-inhibitors, alpha-blockers/agonists, aldosterone receptor blockers, angiotensin II receptor blockers, beta-blockers, calcium channel blockers (non-DH), calcium channel blockers (DH), central alpha-2 agonists, combined A-B blockers, direct vasodilators, diuretics (thiazide), diuretics (loop), and diuretics (K-sparing). (b) Mean percent changes in weight over time by intervention group.

Figure 2.

Percentage of participants with SBP