Intensive Therapy Beneficial in T2D and Early Hypertension

TOPLINE:

Women with type 2 diabetes (T2D) whose hypertension was diagnosed earlier in life are at a greater risk for cardiovascular diseases (CVDs) and may benefit from intensive antihypertensive therapy.

METHODOLOGY:

• Age-related elevation in blood pressure begins earlier in life and faster in women than in men, particularly in the presence of cardiometabolic risk factors such as T2D.
• The ACCORD trial included individuals with T2D who were randomly assigned to receive either intensive (systolic blood pressure < 120 mmHg) or standard (systolic blood pressure < 140 mmHg) antihypertensive treatment targets.
• Of those completing the trial, 3792 participants (49% women) provided data on age at hypertension diagnosis.
• Participants were categorized into men and women with early diagnosed (< 50 years) or late-diagnosed (≥ 50 years) hypertension groups.
• Researchers assessed the incidence of CVD events (coronary heart disease, stroke, heart failure, or cardiovascular death) and the impact of early hypertension diagnosis on incident CVD risk across participant groups over a follow-up duration of 4.5 years.

TAKEAWAY:

• The incidence of CVD events was higher in women with early diagnosed vs late-diagnosed hypertension (hazard ratio [HR], 1.47; P = .005) but not in men (P = .15).
• Intensive vs standard antihypertensive treatment attenuated the excess CVD risk associated with early diagnosed hypertension by 35% in women (HR, 0.65; P = .036), compared with 6% in men (HR, 0.94; P = .76).
• There was an 11% increase in the overall risk for incident CVD (HR, 1.11; P = .006) for each decade earlier at hypertension diagnosis, predominantly observed in women who received standard rather than intensive antihypertensive treatment.

IN PRACTICE:

"Women with type 2 diabetes whose hypertension was diagnosed earlier in life could substantially benefit from intensive over standard antihypertensive treatment," wrote the authors.

SOURCE:

The study, led by Hongwei Ji, Tsinghua Medicine, Tsinghua University, Beijing, was published online on April 24, 2024, in Diabetes Care.

LIMITATIONS:

The trial was open-labeled, and the sample size was relatively limited.

DISCLOSURES:

The study was supported in part by the National Natural Science Foundation of China, the Natural Science Foundation of Shandong Province, Shuimu Scholar Program of Tsinghua University, National Postdoctoral Innovative Talent Support Program, and National Institutes of Health. The authors declared no conflicts of interest.