The Impact of frailty on the effectiveness of intensive blood pressure control for patients with type 2 diabetes: a secondary analysis of a randomised controlled trial
Authors' conclusion
In the ACCORD BP study, the benefit of intensive BP treatment was consistent regardless of frailty in the setting of standard glycaemic control. Frailty should not be a barrier to intensive BP control in patients with T2DM treated with guideline-recommended standard glycaemic control.
Study context
- Population
- Participants with type 2 diabetes mellitus (T2DM) in the ACCORD blood pressure (BP) trial, by frailty status (Rockwood cumulative deficit frailty index)mean age: 62.7 years, 39.9% frailty
- Participants
- 4,733 participants
- Comparison
- Effects of systolic BP (<120 vs <140 mm Hg) and glycaemic control on cardiovascular events in T2DM, according to frailty status
- Primary endpoint
- non-fatal myocardial infarction, non-fatal stroke or death from cardiovascular causes
Methodological detailstwo-by-two factorial trial
- Two-by-two factorial trial
Primary result
As reported in the abstract
intensive vs standardHazard ratio (95% CI)
Standard glycaemic arm; regardless of frailty status (p value for interaction=0.86)
0.75(0.58–0.97)
Intensive glycaemic arm; no benefits observed
1.08(0.82–1.43)
Further findings
Mean average number of antihypertensive medications, frail vs non-frail
- Standard treatment group, frail vs non-frail
- 2.2 vs 1.7
- Intensive treatment group, frail vs non-frail
- 3.1 vs 2.7
Benefit of intensive BP intervention across the spectrum of the frailty index (standard glycaemic arm)
- Consistent across the spectrum of the frailty index
- p value for interaction=0.96
Original publication
The Impact of frailty on the effectiveness of intensive blood pressure control for patients with type 2 diabetes: a secondary analysis of a randomised controlled trial. Heart. Published 6 February 2025. doi:10.
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