BPROAD: Intensive or standard BP treatment strategy in type 2 diabetes?

An intensive blood pressure (BP)-lowering treatment strategy led to fewer major cardiovascular events than a standard BP-lowering treatment strategy in patients with type 2 diabetes and an elevated risk for cardiovascular disease in the randomised-controlled BPROAD study.

Prof. Guang Ning (Shanghai Jiao Tong University School of Medicine, China) and colleagues compared an intensive BP-lowering treatment strategy (i.e. a systolic BP target of <120 mmHg) to the standard BP-lowering treatment strategy (i.e. a systolic BP target of <140 mmHg) among 12,821 participants over 50 years of age with type 2 diabetes, an increased systolic BP, and an increased risk for cardiovascular disease [1]. The primary outcome of the multicentre, open-label, randomised-controlled BPROAD trial (NCT03808311) was a composite of non-fatal myocardial infarction, non-fatal stroke, treated or hospitalised heart failure, and cardiovascular death. “The treatment protocol was flexible in terms of the choice and doses of antihypertensive medications,” said Prof. Ning.

The results showed a swift reduction in systolic BP to a median of 134.3 mmHg in the standard-treatment arm and a reduction to a median of 118.0 mmHg in the intensive-treatment arm (see Figure). These changes were maintained to the end of the study at 4 years of follow-up. Primary outcome events were reported in 2.09% of the participants per year in the standard-treatment group and 1.65% of the participants per year in the intensive-treatment group, a significant difference (HR 0.79; 95% CI 0.69–0.90). “The results were consistent across prespecified subgroups,” added Prof. Ning. The authors noted that hyperkalaemia (2.64% vs 2.01%; P=0.003) and symptomatic hypotension (0.12% vs 0.02%; P=0.05) occurred more frequently in the intensive-treatment group than in the standard-treatment group.

Figure: Systolic blood pressure during follow-up in the BPROAD trial [1]



The BPROAD study showed that an intensive BP-lowering treatment strategy reduced the risk of major cardiovascular events in a population of patients with type 2 diabetes and an elevated risk of cardiovascular disease. “Although we need to monitor patients for hypotension and hyperkalaemia during the start of intensive BP interventions, future guidelines should consider the results of the BPROAD trial with regard to recommendations of BP treatment in patients with type 2 diabetes,” concluded Prof. Ning.

Prof. Dorairaj Prabhakaran, discussant of the trial, mentioned that the intensive strategy means that patients would need up to 5 drugs. “Given that drug availability is a major challenge in most primary care settings, this is not easy to achieve. Innovative implementation approaches, community engagement, and co-design principles are needed to achieve these targets on a global level.”

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   1. Ning G, et al. Effects of Intensive Blood Pressure Control in Patients with Type 2 Diabetes (BPROAD). LBS.01, AHA Scientific Sessions 2024, 16–18 November, Chicago, USA.

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Posted on 3 February 20253 February 2025