Systolic blood pressure control among individuals with type 2 diabetes: A comparative effectiveness analysis of three interventions

Mark A. Espeland, Jeffery Probstfield, Donald Hire, J. Bruce Redmon, Gregory W. Evans, Mace Coday, Cora E. Lewis, Karen C. Johnson, Sharon Wilmoth, Judy Bahnson, Michael F. Dulin, Jennifer B. Green, William C. Knowler, Abbas Kitabchi, Anne L. Murillo, Kwame Osei, Shakaib U. Rehman, Frederick L. Brancati, Lee Swartz, Lawrence CheskinJeanne M. Clark, Kerry Stewart, Richard Rubin, Jean Arceci, Suzanne Ball, Jeanne Charleston, Danielle Diggins, Mia Johnson, Joyce Lambert, Kathy Michalski, Dawn Jiggetts, Chanchai Sapun, George A. Bray, Kristi Rau, Allison Strate, Frank L. Greenway, Donna H. Ryan, Donald Williamson, Brandi Armand, Jennifer Arceneaux, Amy Bachand, Michelle Begnaud, Betsy Berhard, Elizabeth Caderette, Robert W. Jeffery, Scott Crow, E. R. Seaquist, K. A. Peterson, J. L. Feldman, T. J. Mendenhall, Look AHEAD Research Group, ACCORD Study Group

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

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).

Original languageEnglish (US)
Pages (from-to)995-1009
Number of pages15
JournalAmerican journal of hypertension
Volume28
Issue number8
DOIs
StatePublished - May 11 2015

Bibliographical note

Funding Information:
This work was supported by National Heart Lung and Blood Institute contracts N01-HC-95178, N01-HC-95179, N01-HC-95180, N01-HC-95181, N01-HC-95182, N01-HC-95183, N01-HC-95184, and IAA #Y1-HC-9035 and IAA#Y1-HC-1010. Other components of the National Institutes of Health, including the National Institute of, Diabetes and Digestive and Kidney Diseases, the National Institute on Aging, and the National Eye Institute, contributed funding. The Center for Disease Control funded, substudies within ACCORD on cost-effectiveness and health-related quality of life. General Clinical Research Centers provide support at many sites.

Keywords

  • blood pressure
  • blood pressure control
  • blood pressure monitoring
  • comparative effectiveness
  • diabetes
  • hypertension
  • lifestyle intervention
  • obesity

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