Intensive Blood Pressure Control, Falls, and Fractures in Patients with Type 2 Diabetes: The ACCORD Trial
Intensive Blood Pressure Control, Falls, and Fractures in Patients with Type 2 Diabetes: The ACCORD Trial
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DOI：
10.1007/s11606-014-2961-3
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发表时间：
2014-12-01
影响因子：
5.7
通讯作者：
Schwartz, Ann V.
中科院分区：
文献类型：
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作者：
Margolis, Karen L.;Palermo, Lisa;Schwartz, Ann V.
背景技术背景：很少有严格的研究来证实或反驳通常引用的关注，即控制血压至较低阈值可能导致福尔斯和骨折风险增加。为了比较2型糖尿病患者在强化治疗中的福尔斯和骨折，（目标收缩压< 120 mmHg）和标准控制糖尿病心血管风险行动（雅阁）随机试验的血压控制组（目标收缩压< 140 mmHg）参与者：3,099名参与者每年自我报告福尔斯和非脊柱骨折的发生情况。骨折集中判定。主要指标：两个治疗组的福尔斯发生率采用随机效应负二项模型进行比较，骨折风险采用考克斯比例风险模型进行比较。关键结果：两组入组时，平均年龄为62岁，44%为女性，25%为黑人，平均血压为138/75 mmHg。在随访期间，所有类别的药物，特别是噻嗪类利尿剂，更常见于密集组。随访1年后，标准组的平均收缩压为133 +/- 15 mmHg，强化组为119 +/- 14 mmHg。强化治疗组和标准治疗组的调整后福尔斯发生率无差异（62.2/100人-年vs. 74.1/100人-年，RR = 0.84，95% CI 0.54-1.29，p = 0.43）。非脊柱骨折的风险在强化血压组比标准血压组无显著性降低（HR 0.79，95% CI 0.62-1.01，p = 0.06）。我们的结论是，将平均收缩压降至120 mmHg以下的强化降压治疗与福尔斯或非高血压风险增加无关。40至79岁的2型糖尿病患者发生脊柱骨折。
BACKGROUND: There are few rigorous studies to confirm or refute the commonly cited concern that control of blood pressure to lower thresholds may result in an increased risk of falls and fractures.OBJECTIVE: To compare falls and fractures in participants with type 2 diabetes in the intensive (targeting a systolic blood pressure of < 120 mmHg) and standard (targeting a systolic blood pressure of < 140 mmHg) blood pressure control arms of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) randomized trial (N = 4,733).PARTICIPANTS: A subset of 3,099 participants self-reported annually on the occurrence of falls and nonspine fractures. Fractures were centrally adjudicated.MAIN MEASURES: The incidence of falls in the two treatment groups was compared using a random-effects negative binomial model, and fracture risk was compared using Cox proportional hazards models.KEY RESULTS: At enrollment in both groups, the mean age was 62 years, 44 % were women, 25 % were Black, and mean blood pressure was 138/75 mmHg. During follow-up, all classes of medications, particularly thiazide diuretics, were more commonly prescribed in the intensive group. After 1 year of follow-up, the mean systolic blood pressure was 133 +/- 15 mmHg in the standard group and 119 +/- 14 mmHg in the intensive group. The adjusted rate of falls did not differ in the intensive and standard groups (62.2/100 person-years vs. 74.1/100 person-years, RR = 0.84, 95 % CI 0.54-1.29, p = 0.43). The risk of non-spine fractures was nonsignificantly lower in the intensive than in the standard blood pressure group (HR 0.79, 95 % CI 0.62-1.01, p = 0.06).CONCLUSIONS: We conclude that intensive antihypertensive treatment that lowered mean systolic blood pressure to below 120 mmHg was not associated with an increased risk of falls or non-spine fractures in patients age 40 to 79 years with type 2 diabetes.