• Yufang Bi, Mian Li, Yan Liu, Tingzhi Li, Jieli Lu, Peng Duan, Fengmei Xu, Qijuan Dong, Ailiang Wang, Tiange Wang, Ruizhi Zheng, Yuhong Chen, Min Xu, Xiaohu Wang, Xinhuan Zhang, Yanbo Niu, Zhiqiang Kang, Chunru Lu, Jing Wang, Xinwen Qiu, An Wang, Shujing Wu, Jingya Niu, Jingya Wang, Zhiyun Zhao, Huanfeng Pan, Xiaohua Yang, Xiaohong Niu, Shuguang Pang, Xiaoliang Zhang, Yuancheng Dai, Qin Wan, Shihong Chen, Qidong Zheng, Shaoping Dai, Juan Deng, Leshan Liu, Guixia Wang, Huiqi Zhu, Weidong Tang, Haixia Liu, Zhenfang Guo, Guang Ning, Jiang He, Yu Xu, Weiqing Wang, and BPROAD Research Group.
• From the Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, and the National Clinical Research Center for Metabolic Diseases (Shanghai), Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, National Research Center for Translational Medicine, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics (Y.B., M.L., J.L., T.W., R.Z., Y.C., M.X., S.W., J.N., Z.Z., J.D., G.N., Y.X., W.W.), the Lifecycle Health Management Center (Jingya Wang), and the Ruijin-Junshi Clinical Research Center (L.L.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, and the School of Clinical Medicine, Shanghai University of Medicine and Health Sciences (J.N.), Shanghai, the Department of Endocrine and Metabolic Diseases, Third People's Hospital of Datong (Y.L.), and the Department of Endocrine and Metabolic Diseases, Heji Hospital Affiliated to Changzhi Medical College (X.N.), Shanxi, the Department of Endocrine and Metabolic Diseases, First People's Hospital of Loudi (T.L.), and the Department of Endocrine and Metabolic Diseases, People's Hospital of Liuyang (X.Q.), Hunan, the Department of Endocrine and Metabolic Diseases, Third Hospital of Nanchang, Jiangxi (P.D.), the Department of Endocrine and Metabolic Diseases, General Hospital of Hebi Coal Industry Group (F.X.), the Department of Endocrine and Metabolic Diseases, People's Hospital of Zhengzhou (Q.D.), the Department of Endocrine and Metabolic Diseases, People's Hospital of Anyang City (X.W.), the Department of Endocrine and Metabolic Diseases, Zhengzhou Central Hospital (Z.K.), and the Department of Endocrine and Metabolic Diseases, General Hospital of Pingmei Shenma Group (H.Z.), Henan, the Department of Endocrine and Metabolic Diseases, Yankuang New Journey General Hospital (Ailiang Wang), the Department of Endocrinology, Second Affiliated Hospital of Shandong First Medical University (Xinhuan Zhang), the Department of Endocrine and Metabolic Diseases, Weifang Municipal Official Hospital (Jing Wang), the Department of Endocrine and Metabolic Diseases, Jinan Central Hospital Affiliated to Shandong First Medical University (S.P.), the Department of Endocrine and Metabolic Diseases, Weifang Hi-tech Zone People's Hospital (Xiaoliang Zhang), the Department of Endocrine and Metabolic Diseases, Second Hospital of Shandong University (S.C.), and the Department of Endocrine and Metabolic Diseases, Shanghe County People's Hospital (Z.G.), Shandong, the Department of Endocrine and Metabolic Diseases, Tieli People's Hospital (Y.N.), the Department of Endocrine and Metabolic Diseases, Yian County Hospital of Traditional Chinese Medicine (C.L.), and the Department of Endocrine and Metabolic Diseases, Wuchang People's Hospital (W.T.), Heilongjiang, the Department of Endocrine and Metabolic Diseases, Anqing Shihua Hospital of Nanjing Drum Tower Hospital Group (An Wang), and the Department of Endocrine and Metabolic Diseases, Lai'an Jia Ning Hospital (S.D.), Anhui, the Department of Cardiology, Zhongshan Hospital, Fudan University (Xiamen branch), Fujian (S.W.), the Department of Endocrine and Metabolic Diseases, Jilin Municipal People's Hospital (H.P.), and the Department of Endocrine and Metabolic Diseases, First Hospital of Jilin University (G.W.), Jilin, the Department of Endocrine and Metabolic Diseases, Hai'an People's Hospital (X.Y.), and the Department of Endocrine and Metabolic Diseases, Sheyang County Diabetes Hospital (Y.D.), Jiangsu, the Department of Endocrine and Metabolic Diseases, Affiliated Hospital of Southwest Medical University, Sichuan (Q.W.), the Department of Endocrine and Metabolic Diseases, Yuhuan Second People's Hospital, Zhejiang (Q.Z.), and the Department of Endocrine and Metabolic Diseases, Second Hospital of Dalian Medical University, Liaoning (H.L.) - all in China; and the O'Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas (J.H.).
• N. Engl. J. Med. 2024 Nov 16.

BackgroundEffective targets for systolic blood-pressure control in patients with type 2 diabetes are unclear.MethodsWe enrolled patients 50 years of age or older with type 2 diabetes, elevated systolic blood pressure, and an increased risk of cardiovascular disease at 145 clinical sites across China. Patients were randomly assigned to receive intensive treatment that targeted a systolic blood pressure of less than 120 mm Hg or standard treatment that targeted a systolic blood pressure of less than 140 mm Hg for up to 5 years. The primary outcome was a composite of nonfatal stroke, nonfatal myocardial infarction, treatment or hospitalization for heart failure, or death from cardiovascular causes. Multiple imputation was used for missing outcome data, with an assumption that the data were missing at random.ResultsOf 12,821 patients (6414 patients in the intensive-treatment group and 6407 in the standard-treatment group) enrolled from February 2019 through December 2021, 5803 (45.3%) were women; the mean (±SD) age of the patients was 63.8±7.5 years. At 1 year of follow-up, the mean systolic blood pressure was 121.6 mm Hg (median, 118.3 mm Hg) in the intensive-treatment group and 133.2 mm Hg (median, 135.0 mm Hg) in the standard-treatment group. During a median follow-up of 4.2 years, primary-outcome events occurred in 393 patients (1.65 events per 100 person-years) in the intensive-treatment group and 492 patients (2.09 events per 100 person-years) in the standard-treatment group (hazard ratio, 0.79; 95% confidence interval, 0.69 to 0.90; P<0.001). The incidence of serious adverse events was similar in the treatment groups. However, symptomatic hypotension and hyperkalemia occurred more frequently in the intensive-treatment group than in the standard-treatment group.ConclusionsAmong patients with type 2 diabetes, the incidence of major cardiovascular events was significantly lower with intensive treatment targeting a systolic blood pressure of less than 120 mm Hg than with standard treatment targeting a systolic blood pressure of less than 140 mm Hg. (Funded by the National Key Research and Development Program of the Ministry of Science and Technology of China and others; BPROAD ClinicalTrials.gov number, NCT03808311.).Copyright © 2024 Massachusetts Medical Society.

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