Summary: In a post-hoc analysis of 307 ACCORD-BP participants with type 2 diabetes and a prior stroke, intensive systolic blood pressure control (target below 120 mmHg) was associated with a lower 3-year risk of major adverse cardiovascular events than standard control (target below 140 mmHg), with a hazard ratio of 0.55 (95% CI 0.32 to 0.95). Recurrent stroke was numerically lower but not statistically significant (HR 0.65, 95% CI 0.30 to 1.37). As a non-randomised subgroup analysis, the finding is associational rather than confirmatory.
PICO Summary
| Element | Detail |
|---|---|
| Population | 307 patients with type 2 diabetes and a prior stroke, drawn from the 4733 participants of the randomised ACCORD-BP trial (post-hoc subgroup); United States and Canada. |
| Intervention | Intensive systolic blood pressure control, target below 120 mmHg. |
| Comparison | Standard systolic blood pressure control, target below 140 mmHg. |
| Outcome | Major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) at the 3-year conditional landmark: HR 0.55, 95% CI 0.32 to 0.95 (IPTW Cox). Consistent across multivariable Cox (HR 0.53, 95% CI 0.31 to 0.90) and overlap weighting (HR 0.55, 95% CI 0.32 to 0.94). Recurrent stroke: HR 0.65, 95% CI 0.30 to 1.37 (not significant). Absolute risk reduction, NNT, and p values were not reported in the abstract. |
Intensive BP control after stroke in type 2 diabetes
ACCORD-BP post-hoc · type 2 diabetes + prior stroke · 3-year landmark
In this small post-hoc subgroup, an intensive systolic target (<120 mmHg) was associated with ~45% fewer major cardiovascular events than standard control. As a non-randomised analysis it is hypothesis-generating, not practice-changing.
Expert Commentary
This analysis suggests that, among the small group of ACCORD-BP participants who had both type 2 diabetes and a prior stroke, an intensive systolic target was associated with roughly a 45 percent relative reduction in major cardiovascular events over the landmark period, a signal that held across three weighting approaches. The verdict, however, must be tempered. This is a post-hoc subgroup of only 307 patients, and the intensive-versus-standard contrast within that subgroup was reconstructed using inverse probability weighting rather than preserved randomisation, so the result is associational and hypothesis-generating, not confirmatory of benefit. The single most weighty limitation is therefore residual confounding: weighting can balance measured covariates but cannot guarantee that the two groups were otherwise comparable, and the wide confidence intervals reflect how few events the subgroup contained. The recurrent-stroke signal was reassuring in direction but did not reach significance, and the abstract reported no offsetting harm in this subgroup. Can I use this with my patients? Not yet as a target change. For a patient with type 2 diabetes and a prior stroke it is reasonable to individualise toward tighter control if tolerated, but this should be framed by guideline targets and the original trial, not driven by a small secondary analysis. A dedicated randomised trial in this exact population is needed before practice should move.
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