title: Effect of Intensive Blood Pressure Lowering on Incident Atrial Fibrillation and P-Wave Indices in the ACCORD Blood Pressure Trial.
abstract: There are no proven strategies to prevent atrial fibrillation (AF) in patients with type 2 diabetes (T2DM). We compared standard blood pressure (BP) lowering vs. intensive BP lowering in reducing incidence of AF or P-wave indices (PWI-ECG markers of left atrial abnormality that are considered intermediate phenotypes of AF) in patients with T2DM.
  
  
  
  We analyzed data from the ACCORD BP trial-a randomized controlled nonblinded trial (2001-2009) which randomized patients with T2DM and systolic BP (SBP) 130-180mm Hg on ≤3 antihypertensive medications aged 40-79 years with cardiovascular disease (CVD) or aged 55-79 years with subclinical CVD or ≥2 CVD risk factors to standard BP lowering (SBP <140mm Hg) vs. intensive BP lowering (SBP <120mm Hg). The primary outcome was a composite of incident AF and PWI.
  
  
  
  Data from 3,087 participants (mean age, 62.2 years; women, 48.2%; non-White, 39.2%) were analyzed. During a mean follow-up of 4.4 years, the primary outcome occurred in 1,063 participants (incidence rate, 84.5 per 1,000 person-years in the standard-therapy group vs. 73.9 per 1,000 person-years in the intensive-therapy group). The adjusted hazard ratios (95% confidence intervals) of intensive-therapy group for the primary outcome and for incident PWI alone were 0.87 (0.77-0.98), P = 0.02 and 0.87 (0.76-0.98), P = 0.02, respectively. The effect of intensive therapy on the incidence of AF alone did not reach statistical significance.
  
  
  
  In patients with T2DM, intensive BP lowering reduces the incidence of the composite outcome of AF and PWI, suggesting a potential benefit from stringent BP control in patients with T2DM. clinical trials registration Trial Number NCT00000620.
authors.affiliation: Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
authors.forename: Lin Y
authors.initials: LY
authors.lastname: Chen
authors.affiliation: Columbia University Department of Medicine, Division of Cardiology, New York, New York, USA.
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Bigger
authors.affiliation: Columbia University Department of Medicine, Division of Cardiology, New York, New York, USA.|Columbia University School of Nursing, New York, New York, USA.
authors.forename: Kathleen T
authors.initials: KT
authors.lastname: Hickey
authors.affiliation: Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Haiying
authors.initials: H
authors.lastname: Chen
authors.affiliation: Columbia University Department of Medicine, Division of Cardiology, New York, New York, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Lopez-Jimenez
authors.affiliation: SUNY Downstate Medical Center, Brooklyn, New York, USA.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Banerji
authors.affiliation: Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Evans
authors.affiliation: Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Jerome L
authors.initials: JL
authors.lastname: Fleg
authors.affiliation: The Veterans Administration Medical Center, Washington, DC, USA.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Papademetriou
authors.affiliation: Endocrinology, Diabetes, Bone and Mineral Disorders Division, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Abraham
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Section of Endocrinology and Metabolism, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Vincent
authors.initials: V
authors.lastname: Woo
authors.affiliation: Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Seaquist
authors.affiliation: Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Division of Public Health Sciences, Winston-Salem, North Carolina, USA.|Department of Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control; D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents