Summary: Among 307 patients with type 2 diabetes and a prior stroke drawn from the ACCORD-BP trial, this post-hoc analysis found that intensive systolic blood pressure control targeting below 120 mmHg was associated with a lower risk of major adverse cardiovascular events than standard control below 140 mmHg (HR 0.55, 95% CI 0.32-0.95) at a 3-year landmark. A trend toward fewer recurrent strokes did not reach significance (HR 0.65, 95% CI 0.30-1.37).
PICO Summary
| Element | Detail |
|---|---|
| Population | 307 adults with type 2 diabetes and a prior stroke, a post-hoc subgroup of the 4733-patient ACCORD-BP randomised trial (USA and Canada). |
| Intervention | Intensive systolic blood pressure control targeting below 120 mmHg (the intensive ACCORD-BP arm). |
| Comparison | Standard systolic blood pressure control targeting below 140 mmHg (the standard ACCORD-BP arm). |
| Outcome | At a 3-year conditional landmark, intensive control was associated with lower MACE (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke): HR 0.55 (95% CI 0.32-0.95) by IPTW Cox, consistent in multivariable Cox (HR 0.53, 95% CI 0.31-0.90) and overlap weighting (HR 0.55, 95% CI 0.32-0.94). Recurrent stroke showed a non-significant trend (HR 0.65, 95% CI 0.30-1.37). Absolute event counts, ARR, and NNT were not reported. |
Intensive SBP <120 mmHg in diabetes with prior stroke
ACCORD-BP post-hoc · type 2 diabetes · 3-year landmark
In this 307-patient post-hoc subgroup, targeting SBP below 120 mmHg was associated with lower MACE than below 140 mmHg, but the result is fragile and hypothesis-generating, not a target change.
Expert Commentary
This is a hypothesis-generating signal, not confirmatory evidence. Although the parent ACCORD-BP study was a randomised trial, the present analysis is a post-hoc examination of a 307-patient subgroup defined by prior stroke, with treatment effects estimated through inverse probability of treatment weighting and a 3-year conditional landmark. That design makes the result associational rather than a clean randomised comparison, and the consistency seen across the weighting and multivariable models reflects analytical robustness rather than freedom from residual confounding or selection by the landmark. The single weighed limitation worth foregrounding is statistical fragility: with only 307 patients and a MACE confidence interval reaching 0.95, the finding sits at the edge of significance and could be overturned by a handful of events. The recurrent-stroke result was not significant and should be read as no demonstrated effect. Can I use this with my patients? Not yet as a target change. For a patient with type 2 diabetes and a previous stroke who already tolerates lower pressures, it offers gentle reassurance that aiming below 120 mmHg did not increase recurrent stroke in this subgroup, but it does not justify routinely intensifying therapy on its own. I would treat it as a prompt to follow the dedicated randomised trials now testing tighter targets in this exact population, and to weigh tolerability, falls, and renal function before pushing any individual lower.
References
Wang Z, Wang J, He L, Jiang C, Wang Y, Shen T, et al. Intensive Blood Pressure Control in Patients With Diabetes and Previous Stroke: A Post-Hoc Analysis of ACCORD-BP Trial. J Clin Hypertens (Greenwich). 2025;27(7):e70095. doi:10.1111/jch.70095