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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, William C. Cushman
American journal of hypertension 2015 v.28 no.8 pp. 995-1009
adults, body mass index, clinical trials, drug therapy, education, equations, hypertension, lifestyle, monitoring, noninsulin-dependent diabetes mellitus, overweight, risk, systolic blood pressure, weight loss
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.