What was the findings of the meta-analyses of RCTs of diabetes conducted prior to ACCORD and SPRINT?
The meta-analyses of RCTs conducted prior to ACCORD and SPRINT found that SBP lowering decreases the CV event rate and perhaps mortality and kidney outcomes. Ettehad et al. reported that the reduction in major CV events remained proportional to the BP reduction achieved among trial participants with diabetes, but that the proportional risk reductions were smaller than the reductions in those without diabetes. Malhotra et al. found no evidence of heterogeneity in beneficial effects on mortality with respect to the presence or absence of diabetes. Brunström et al. found that BP reduction decreased MI, stroke, CV mortality, ESKD, and all-cause mortality if baseline SBP was >150 mm Hg; there was decreased MI, HF, and all-cause mortality if baseline SBP was 140 to 150 mm Hg, but paradoxically, increased CV mortality was observed if baseline SBP was <140 mm Hg.