Evidence map›Paper›PMID 20228401›Full record

Trial reportThe New England journal of medicine2010

Effects of intensive blood-pressure control in type 2 diabetes mellitus.

ACCORD Study Group, William C Cushman, Gregory W Evans, Robert P Byington, David C Goff, Richard H Grimm, Jeffrey A Cutler, Denise G Simons-Morton, Jan N Basile, Marshall A Corson and 8 more

7 registry-linked trialsAbstract readMulticenter StudyRandomized Controlled Trial
In one paragraph

Trial report in The New England journal of medicine, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It reports registered trial NCT00000620. Cited by 1,268 papers, 25 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1,268citing papers in PubMed, 25 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00000620 phase3completed

Action to Control Cardiovascular Risk in Diabetes (ACCORD)

Ran1999Enrolled10,251Registered outcomes6Posted comparisons6ConditionsAtherosclerosis, Cardiovascular Diseases, Coronary Disease, Diabetes MellitusArmsAnti-hyperglycemic Agents, Anti-hypertensive Agents, Blinded fenofibrate or placebo plus simvastatin
Open the trial in the graph
NCT02633488 nacompletedstarted 2014, after this paper: background citation

Effect of Metformin on Insulin Sensitivity and Pan-Arterial Vascular Function in Adults With Metabolic Syndrome

Ran2014Enrolled19Registered outcomes1Posted comparisons1ConditionsInsulin Sensitivity, Metabolic SyndromeArmsMetformin, Placebos
Open the trial in the graph
NCT01828970 phase4completednot on this map

Glycemic Control Assessed by Continuous Glucose Monitoring in Hemodialyzed Patients With Diabetes Mellitus Treated Via the Basal-Bolus Detemir-Aspart Insulin Regimen: A Pilot Study

TypeinterventionalSponsorCentre Europeen d'Etude du DiabeteRan2010 to 2012Enrolled38ConditionsDiabetes MellitusArmsBasal-bolus detemir-aspart insulin regimen
NCT01945268 phase4completednot on this mapstarted 2015, after this paper: background citation

A Randomized Controlled Trial of Influenza Vaccine to Prevent Adverse Vascular Events: A Pilot Study

TypeinterventionalSponsorMcMaster UniversityRan2015 to 2015Enrolled107ConditionsHeart FailureArmsinactivated trivalent influenza vaccine, Sterile saline
NCT02762851 phase4unknown statusnot on this mapstarted 2016, after this paper: background citation

A Randomized Controlled Trial of Influenza Vaccine to Prevent Adverse Vascular Events

TypeinterventionalSponsorMcMaster UniversityRan2016 to 2020Enrolled5,000ConditionsHeart Failure, InfluenzaArmsSterile saline, inactivated trivalent influenza vaccine
NCT03015311 naunknown statusnot on this mapstarted 2017, after this paper: background citation

Strategy of Systolic Blood Pressure Intervention in the Elderly Hypertensive Patients: A Prospective Randomized Open-Label Blinded-Endpoint Trial

TypeinterventionalSponsorChinese Academy of Medical Sciences, Fuwai HospitalRan2017 to 2021Enrolled8,000ConditionsPrimary HypertensionArmsIntensive BP control, Standard BP control
NCT04927299 phase3completednot on this mapstarted 2022, after this paper: background citation

Confirmatory Study of the Efficacy and Safety of the Combination of Losartan / Chlorthalidone vs Losartan / Hydrochlorothiazide in the Treatment of Patients With Essential Arterial Hypertension

TypeinterventionalSponsorLaboratorios Silanes S.A. de C.V.Ran2022 to 2023Enrolled163ConditionsEssential Arterial HypertensionArmsLosartan/Chlorthalidone in fixed dose, Losartan + hydrochlorothiazide in fixed dose
3 · Its place in the literature

Who cites it

1,268 citing papers in PubMed, 25 syntheses or guidelines pooled it.

  1. Pooled it
  2. Blood pressure targets for hypertension in people with diabetes mellitus.The Cochrane database of systematic reviews · 2026
    Pooled it
  3. Guideline
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  5. Intensive Versus Standard Blood Pressure Control in Type 2 Diabetes: Cardiovascular and Microvascular Outcomes.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2026
    Pooled it
  6. Pooled it
  7. Guideline
  8. Guideline
  9. Pooled it
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  15. Guideline
  16. A European Renal Association (ERA) synopsis for nephrology practice of the 2023 European Society of Hypertension (ESH) Guidelines for the Management of Arterial Hypertension.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2024
    Guideline
  17. Pooled it
  18. Urinary Biomarkers and Kidney Injury in VA NEPHRON-D: Phenotyping Acute Kidney Injury in Clinical Trials.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2024
    Pooled it
  19. Pooled it
  20. Pooled it

1,208 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

18 authors.

ACCORD Study Group
William C Cushman
Gregory W Evans
Robert P Byington
David C Goff
Richard H Grimm
Jeffrey A Cutler
Denise G Simons-Morton
Jan N Basile
Marshall A Corson
Jeffrey L Probstfield
Lois Katz
Kevin A Peterson
William T Friedewald
John B Buse
J Thomas Bigger
Hertzel C Gerstein
Faramarz Ismail-Beigi

Funding

Fatty Acid Regulation of Liver Lipoprotein ProductionR01HL073030 · NHLBI · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI GINSBERG, HENRY N · 2003 to 2011
$3.6M
PREVENTION OF CARDIOVASCULAR DISEASE IN DIABETES MELLITUN01HC095183 · HC · MINNEAPOLIS MEDICAL RESEARCH FDN, INC. · PI GRIMM, RICHARD H · 1999 to 2000
$1.9M
PREVENTION OF CARDIOVASCULAR DISEASE IN DIABETES MELLITUN01HC095181 · HC · CASE WESTERN RESERVE UNIVERSITY · PI THIBONNIER, MARC · 1999 to 2000
$1.8M
PREVENTION OF CARDIOVASCULAR DISEASE IN DIABETES MELLITUN01HC095184 · HC · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI BIGGER, J T · 1999 to 2000
$1.7M
PREVENTION OF CARDIOVASCULAR DISEASE IN DIABETES MELLITUN01HC095182 · HC · WAKE FOREST UNIVERSITY · PI GOFF, DAVID C · 1999 to 2000
$1.6M
PREVENTION OF CARDIOVASCULAR DISEASE IN DIABETES MELLITUS-N01HC95178N01HC095178 · HC · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI BYINGTON, ROBERT · 1999 to 2006
$1.5M
PREVENTION OF CARDIOVASCULAR DISEASE IN DIABETER MELLLITN01HC095180 · HC · UNIVERSITY OF WASHINGTON · PI PROBSTFIELD, JEFFREY · 1999 to 2000
$1.5M
S-nitrosothiol analyzer for the clinical diagnosis of cardiovascular disease markR44HL095181 · NHLBI · ACCORD BIOMATERIALS, INC. · PI PISANO, MICHAEL R · 2010 to 2011
$1.4M
PREVENTION OF CARDIOVASCULAR DISEASE IN DIABETES MELLITUN01HC095179 · HC · MCMASTER UNIVERSITY · PI GERSTEIN, HERTZEL C · 1999 to 2000
$1.3M
S-nitrosothiol analyzer for the clinical diagnosis of cardiovascular disease markR43HL095181 · NHLBI · ACCORD BIOMATERIALS, INC. · PI HANDA, HILTESH · 2009 to 2009
$93k
NHLBI NIH HHS N01 HC095178NHLBI NIH HHS N01 HC095179NHLBI NIH HHS N01 HC095180NHLBI NIH HHS N01 HC095181NHLBI NIH HHS N01 HC095182NHLBI NIH HHS N01 HC095183NHLBI NIH HHS N01 HC095184NHLBI NIH HHS N01-HC-95178NHLBI NIH HHS N01-HC-95179NHLBI NIH HHS N01-HC-95180NHLBI NIH HHS N01-HC-95181NHLBI NIH HHS N01-HC-95182NHLBI NIH HHS N01-HC-95183NHLBI NIH HHS N01-HC-95184NHLBI NIH HHS R01 HL073030NHLBI NIH HHS Y01 HC001010NHLBI NIH HHS Y1-HC-1010NHLBI NIH HHS Y1-HC-9035
6 · The paper itself

Abstract

backgroundThere is no evidence from randomized trials to support a strategy of lowering systolic blood pressure below 135 to 140 mm Hg in persons with type 2 diabetes mellitus. We investigated whether therapy targeting normal systolic pressure (i.e., <120 mm Hg) reduces major cardiovascular events in participants with type 2 diabetes at high risk for cardiovascular events.

methodsA total of 4733 participants with type 2 diabetes were randomly assigned to intensive therapy, targeting a systolic pressure of less than 120 mm Hg, or standard therapy, targeting a systolic pressure of less than 140 mm Hg. The primary composite outcome was nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The mean follow-up was 4.7 years.

resultsAfter 1 year, the mean systolic blood pressure was 119.3 mm Hg in the intensive-therapy group and 133.5 mm Hg in the standard-therapy group. The annual rate of the primary outcome was 1.87% in the intensive-therapy group and 2.09% in the standard-therapy group (hazard ratio with intensive therapy, 0.88; 95% confidence interval [CI], 0.73 to 1.06; P=0.20). The annual rates of death from any cause were 1.28% and 1.19% in the two groups, respectively (hazard ratio, 1.07; 95% CI, 0.85 to 1.35; P=0.55). The annual rates of stroke, a prespecified secondary outcome, were 0.32% and 0.53% in the two groups, respectively (hazard ratio, 0.59; 95% CI, 0.39 to 0.89; P=0.01). Serious adverse events attributed to antihypertensive treatment occurred in 77 of the 2362 participants in the intensive-therapy group (3.3%) and 30 of the 2371 participants in the standard-therapy group (1.3%) (P<0.001).

conclusionsIn patients with type 2 diabetes at high risk for cardiovascular events, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, did not reduce the rate of a composite outcome of fatal and nonfatal major cardiovascular events. (ClinicalTrials.gov number, NCT00000620.)

Indexed as

AgedAntihypertensive AgentsBlood PressureCardiovascular DiseasesCreatinineDiabetes Mellitus, Type 2FemaleGlomerular Filtration RateHumansHypertensionHypokalemiaKaplan-Meier EstimateMaleMiddle AgedMyocardial InfarctionProportional Hazards ModelsAntihypertensive AgentsCreatinine

Identifiers

PMID20228401
PMCPMC4123215

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.