Optimizing benefits of intensive SBP control in type 2 diabetes: the crucial role of angiotensin-converting enzyme inhibitors/angiotensin-II type 2 receptor blockers

Aims: Intensive SBP control reduces major cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM) and hypertension, but no information regarding the preferred antihypertensive regimen could be available. The present study aims to investigate the most effective antihypertensive regimen for reducing MACE in these patients. Methods: Participants from the ACCORD BP trial with intensive SBP control were included. Cox proportional hazards models were used to analyze the effects of various antihypertensive regimens on MACE and all-cause mortality. Cost-effectiveness analysis was evaluated using the Markov model. Potential deaths averted were projected based on the referenced data from NHANES cohort. Results: A total of 2362 patients with T2DM and hypertension were included. ACEI/ARB-based antihypertensive regimen, but not other antihypertensive drugs-based ones, were associated with a reduced risk of MACE, and the protective efficiencies were similar across the whole cohort (standard and intensive glycemia control), intensive SBP control cohort [hazard ratio = 0.558, 95% confidence interval (95% CI): 0.420–0.741], standard glycemia/intensive SBP control cohort (hazard ratio = 0.563, 95% CI: 0.373–0. 850), and propensity score-matched standard glycemia/intensive SBP control cohort (hazard ratio = 0.522, 95% CI: 0.315–0.864). The protections were more prominent in patients with older age, CVD history, baseline SBP at least 140 mmHg, and higher Framingham score. All-cause mortality was also reduced with this regimen. Moreover, it was predicted to increase 2.18 quality-adjusted life years and to produce $29 611.97 net monetary benefit and was projected to prevent 494 742 deaths per year in the USA. Conclusion: In patients with hypertension and T2DM, ACEI/ARB is the mandatory antihypertensive medication if intensive SBP control implemented for better clinical benefits.