Summary: In a post-hoc analysis of ACCORD-BP restricted to patients with diabetes and prior stroke, intensive systolic blood pressure control below 120 mmHg was associated with roughly half the rate of major cardiovascular events, without a significant increase in recurrent stroke.
PICO Summary
| Element | Detail |
|---|---|
| Population | 307 patients with type 2 diabetes and prior stroke, drawn from the 4733-patient ACCORD-BP trial (post-hoc subgroup). |
| Intervention | Intensive systolic blood pressure control, target <120 mmHg. |
| Comparison | Standard control, target <140 mmHg. |
| Outcome | At the 3-year landmark, intensive control was associated with lower MACE (HR 0.55; 95% CI 0.32–0.95; consistent across models). Recurrent stroke trended lower but was not significant (HR 0.65; 95% CI 0.30–1.37). In the parent ACCORD-BP trial, intensive control increased serious treatment-related adverse events. |
Intensive BP control after stroke in diabetes
Post-hoc ACCORD-BP · type 2 diabetes + prior stroke · 3-year landmark
In diabetics with prior stroke, a sub-120 mmHg target was linked to roughly half the rate of major cardiovascular events, with no significant rise in recurrent stroke. A small post-hoc subgroup, so hypothesis-generating rather than practice-defining.
Expert Commentary
This addresses a real gap, since SPRINT excluded diabetics and the parent ACCORD-BP trial was neutral on its primary composite, leaving the diabetic-plus-prior-stroke patient poorly served by direct evidence. The signal here is encouraging, a halving of major cardiovascular events with a sub-120 target, and notably no significant rise in recurrent stroke, which is the complication one would most fear when pushing pressure low in cerebrovascular disease. I have corrected the earlier title’s implication that this analysis showed increased adverse events: the abstract reports benefit without a significant stroke increase, and the hypotension and electrolyte concerns belong to the parent trial rather than being demonstrated in this subgroup. The dominant caveat is design: this is a post-hoc subgroup of 307 patients with wide confidence intervals, hypothesis-generating rather than practice-defining, and vulnerable to the usual subgroup pitfalls. Can I use this with my patients? Cautiously and in the direction guidelines already point. For a diabetic patient with prior stroke who tolerates treatment, it supports an intensive target around 120–130 mmHg with close monitoring for hypotension and electrolytes, individualised and backed off if not tolerated. I would not treat one subgroup analysis as definitive.
References
Wang Z, Wang J, He L, 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