title: Systolic Blood Pressure Control Among Individuals With Type 2 Diabetes: A Comparative Effectiveness Analysis of Three Interventions.
abstract: BACKGROUND
  The relative effectiveness of 3 approaches to blood pressure control-(i) an intensive lifestyle intervention (ILI) focused on weight loss, (ii) frequent goal-based monitoring of blood pressure with pharmacological management, and (iii) education and support-has not been established among overweight and obese adults with type 2 diabetes who are appropriate for each intervention.
  
  
  METHODS
  Participants from the Action for Health in Diabetes (Look AHEAD) and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) cohorts who met criteria for both clinical trials were identified. The proportions of these individuals with systolic blood pressure (SBP) <140 mm Hg from annual standardized assessments over time were compared with generalized estimating equations.
  
  
  RESULTS
  Across 4 years among 480 Look AHEAD and 1,129 ACCORD participants with baseline SBPs between 130 and 159 mm Hg, ILI (OR = 1.46; 95% CI = [1.18-1.81]) and frequent goal-based monitoring with pharmacotherapy (OR = 1.51; 95% CI = [1.16-1.97]) yielded higher rates of blood pressure control compared to education and support. The intensive behavioral-based intervention may have been more effective among individuals with body mass index >30 kg/m2, while frequent goal-based monitoring with medication management may be more effective among individuals with lower body mass index (interaction P = 0.047).
  
  
  CONCLUSIONS
  Among overweight and obese adults with type 2 diabetes, both ILI and frequent goal-based monitoring with pharmacological management can be successful strategies for blood pressure control.
  
  
  BACKGROUND
  clinicaltrials.gov identifiers NCT00017953 (Look AHEAD) and NCT00000620 (ACCORD).
authors: Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; mespelan@wakehealth.edu.
authors: Mark A
authors: MA
authors: Espeland
authors: University of Washington, Seattle, Washington, USA;
authors: Jeffery
authors: J
authors: Probstfield
authors: Wake Forest School of Medicine, Winston-Salem, North Carolina, USA;
authors: Donald
authors: D
authors: Hire
authors: University of Minnesota, Minneapolis, Minnesota, USA;
authors: J Bruce
authors: JB
authors: Redmon
authors: Wake Forest School of Medicine, Winston-Salem, North Carolina, USA;
authors: Gregory W
authors: GW
authors: Evans
authors: The University of Tennessee Health Science Center, Memphis, Tennessee, USA;
authors: Mace
authors: M
authors: Coday
authors: The University of Alabama at Birmingham, Birmingham, Alabama, USA;
authors: Cora E
authors: CE
authors: Lewis
authors: The University of Tennessee Health Science Center, Memphis, Tennessee, USA;
authors: Karen C
authors: KC
authors: Johnson
authors: Wake Forest School of Medicine, Winston-Salem, North Carolina, USA;
authors: Sharon
authors: S
authors: Wilmoth
authors: Wake Forest School of Medicine, Winston-Salem, North Carolina, USA;
authors: Judy
authors: J
authors: Bahnson
authors: Carolinas Medical Center, Charlotte, North Carolina, USA;
authors: Michael F
authors: MF
authors: Dulin
authors: Duke University Medical Center, Durham, North Carolina, USA;
authors: Jennifer B
authors: JB
authors: Green
authors: Diabetes Epidemiology and Clinical Research Section, NIDDK, Phoenix, Arizona, USA;
authors: William C
authors: WC
authors: Knowler
authors: The University of Tennessee Health Science Center, Memphis, Tennessee, USA;
authors: Abbas
authors: A
authors: Kitabchi
authors: University of Washington, Seattle, Washington, USA;
authors: Anne L
authors: AL
authors: Murillo
authors: Internal Medicine, Ohio State University, Columbus, Ohio, USA;
authors: Kwame
authors: K
authors: Osei
authors: Phoenix VA Health Care System, Phoenix, Arizona, USA;
authors: Shakaib U
authors: SU
authors: Rehman
authors: Veterans Affairs Medical Center, Memphis, Memphis, Tennessee, USA.
authors: William C
authors: WC
authors: Cushman
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004035:Diet Therapy / Q000379:methods*; D004038:Diet, Reducing / Q000379:methods; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009765:Obesity / Q000150:complications / Q000628:therapy*; D050177:Overweight / Q000150:complications / Q000628:therapy; D010353:Patient Education as Topic / Q000379:methods; D012648:Self Care
chemical_list: D000959:Antihypertensive Agents
keywords: blood pressure; blood pressure control; blood pressure monitoring; comparative effectiveness; diabetes; hypertension; lifestyle intervention; obesity.