New BPROAD Trial Confirms Benefits of Intensive BP Treatment for Diabetics
In a groundbreaking development for diabetes management, a new study—the BPROAD trial—has confirmed that intensively treating systolic blood pressure (BP) below 120 mm Hg significantly reduces the risk of major cardiovascular events in patients with type 2 diabetes and hypertension. This finding aligns with previous studies involving nondiabetic populations and has potential implications for altering treatment protocols for millions of people worldwide.
Understanding the BPROAD Trial
Conducted in China, the BPROAD trial involved over 12,800 patients diagnosed with type 2 diabetes who also exhibited hypertension. Between February 2019 and December 2021, participants aged about 63.8 years, of whom 45.3% were women, were randomly assigned to adopt a more rigorous BP-lowering intervention targeting systolic numbers below 120 mm Hg, compared to the standard goal of less than 140 mm Hg.
Researchers, including first author Dr. Yufang Bi from Shanghai Jiao Tong University, evaluated cardiovascular outcomes over four years. The key result demonstrated that intensive treatment provided significant reductions in the incidence of adverse cardiovascular events, affirming that diabetic patients respond similarly to BP treatments as their nondiabetic counterparts, thereby filling a critical knowledge gap established by previous studies.
Contrasting Findings: SPRINT and ACCORD Trials
The results of BPROAD echo those of the SPRINT trial conducted in 2015, which set a precedent by recommending BP treatment goals below 130/80 mm Hg. However, they stand in contrast to findings from the ACCORD trial of 2010, which examined both lipid control and blood pressure but found no significant cardiovascular benefit from intensive blood pressure management in diabetic patients. Dr. Shawna Nesbitt of UT Southwestern Medical Center noted that this disconnect made previous interpretations of blood pressure treatment for diabetics unclear.
“The BPROAD trial now confirms that diabetics actually have the same response as nondiabetics in terms of blood pressure treatments,” Nesbitt remarked during a media briefing with TCTMD.
Expert Insights
Dr. John McEvoy, co-chair of the European Society of Cardiology (ESC) hypertension guidelines, expressed his positive surprise regarding BPROAD’s findings. He highlighted that recent guidelines recommended treating patients with diabetes to the same targets as those with other high cardiovascular disease risks.
Amit Khera, a prominent figure in diabetes management, emphasized the significance of these findings: “Now we have to work towards implementing these important findings into millions of individuals worldwide with diabetes.”
Efficacy and Safety Considerations
While BPROAD demonstrated that intensive systolic BP lowering decreased significant cardiovascular events, it also raised concerns about potential adverse effects. Rates of serious adverse events were comparable between treatment groups, at around 36%. However, researchers noted higher occurrences of symptomatic hypotension and hyperkalemia in the intensive treatment cohort.
- Hypotension: 0.1% in intensive group vs. standard treatment
- Hyperkalemia: 2.8% in intensive group vs. 2.0% in standard treatment
- Albuminuria: Lower incidence in intensive group (11.29 vs. 13.84 events per 100 person-years)
These findings underscore the necessity for careful monitoring during the initiation of intensive treatment, particularly in elderly populations.
Looking Ahead
Nesbitt poignantly remarked on the trial’s implications, stating, “While we are very happy to see that the results of reducing blood pressure do reduce events, we do have to be concerned about the serious adverse events that these changes in blood pressure may cause, particularly in elderly people.”
With BPROAD reinforcing the significance of aggressive blood pressure management in diabetic patients, health professionals are poised to recommend these practices actively. As McEvoy notes, there is “no biological plausibility” that diabetic patients would respond differently to blood pressure treatment, reinforcing the idea that the ACCORD trial was an outlier in the research landscape.
The groundbreaking results of BPROAD pave the way for revisiting treatment protocols worldwide. As the medical community grapples with integrating new evidence into practice, the dialogue surrounding patient safety, treatment efficacy, and overall best practices continues to evolve.
Readers are invited to share their thoughts on how this new information may alter your perceptions about diabetes management or any experiences you may have in dealing with blood pressure treatments. Your insights could contribute to vital discussions surrounding this critical topic.
