Carvalho, D

Dias, C

Leitão, L

Magriço, R

Neves, J

Oliveira, AI

Vieira, M

English

João Sérgio Neves

Miguel Bigotte Vieira

Lia Leitão

Catarina Viegas Dias

Rita Magriço

Ana Isabel Oliveira

Davide Carvalho

Crossref

Diabetes Care

Comment on Bress et al. Effect of Intensive Versus Standard Blood Pressure Treatment According to Baseline Prediabetes Status: A Post Hoc Analysis of a Randomized Trial. Diabetes Care 2017;40:1401–1408

Repositório do Hospital Prof. Doutor Fernando Fonseca

COMMENT ON BRESS ET AL.Effect of Intensive Versus Standard BloodPressure Treatment According to BaselinePrediabetes Status: A Post Hoc Analysisof a Randomized Trial. Diabetes Care2017;40:1401–1408Diabetes Care 2018;41:e88–e89 | https://doi.org/10.2337/dc17-2311We read with interest the article by Bresset al. (1) reporting on the effect of inten-sive versus standard blood pressure treat-ment according to baseline prediabetesstatus in a post hoc analysis of the Sys-tolic Blood Pressure Intervention Trial(SPRINT). The authors concluded thatthe beneﬁcial effects of intensive bloodpressure treatment were similar amongpatients with prediabetes and patientswith normoglycemia. We have partici-pated in the SPRINT Data Analysis Chal-lenge (2), andwe also analyzed the effectsof glycemia status in this population.Whereas we agree with the conclusionspresented by the authors, we believe it isalso important to assess the effect of pre-diabetes on cardiovascular events anddeath in patients at high risk for cardio-vascular events.Previous studies have reported an in-crease incardiovascular riskamongpatientswith prediabetes (3–5). However, most ofthese trials have evaluated patients at lowor moderate cardiovascular risk (3–5).Using the SPRINT challenge data set,we evaluated the occurrence of the pri-mary outcome (composite of myocardialinfarction, acute coronary syndrome notresulting in myocardial infarction, stroke,acute decompensated heart failure, ordeath from cardiovascular causes) andthe SPRINT secondary outcomes amongpatients with prediabetes comparedwith patients with normoglycemia. Weused Cox proportional hazards regressionmodels to test for an association betweenprediabetes and each outcome. We alsotested this association adjusting for age,sex, baseline systolic blood pressure,smoking, chronic kidney disease, cardio-vascular disease at baseline, black race,BMI, statins and aspirin use, and treat-ment arm. The unadjusted hazard ratiofor the primary outcome was 1.08 (95%CI 0.91, 1.28; P = 0.390) in patients withprediabetes compared with patients withnormoglycemia. The adjusted hazardratio for the primary outcome was 1.05(0.88, 1.25; P = 0.560) in patients withprediabetes compared with patientswith normoglycemia. We also found nosigniﬁcant differences regarding the pre-speciﬁed secondary outcomes of SPRINT.Webelieve our results are important asthey suggest that prediabetes status maynot increase cardiovascular risk among pa-tients athigh risk for cardiovascular events,in contrast with what has been describedin patients with low cardiovascular risk.Note that, as in the article by Bresset al. (1), this analysis was not prespeci-ﬁed and that SPRINT was not designed toanswer this question. We cannot excludethat the risk of patients with prediabetesmight have been higher if the follow-uphad been longer or if prediabetes statushad been deﬁned by HbA1c levels and/ororal glucose tolerance tests.In summary, the results fromSPRINTnotonly highlight that intensive bloodpressure is beneﬁcial in both patientswith prediabetes and patients with nor-moglycemia but also suggest that predi-abetes does not further increasecardiovascular risk among patients athigh risk for cardiovascular events.Duality of Interest. No potential conﬂicts of in-terest relevant to this article were reported.References1. Bress AP, King JB, Kreider KE, et al.; SPRINTResearch Group. Effect of intensive versus stan-dard blood pressure treatment according to base-line prediabetes status: a post hoc analysis of arandomized trial. Diabetes Care 2017;40:1401–14082. Burns NS, Miller PW. Learning what we didn’tknow - the SPRINTDataAnalysis Challenge. N EnglJ Med 2017;376:2205–22071Department of Endocrinology, Diabetes and Metabolism, São João Hospital Center, Porto, Portugal2Department of Surgery and Physiology and Cardiovascular Research Center, Faculty of Medicine, University of Porto, Porto, Portugal3Nephrology and Renal Transplantation Department, Centro Hospitalar Lisboa Norte, Lisbon, Portugal4Neurology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal5Family Health Unit of Dafundo, Agrupamento de Centros de Sau´de Lisboa Ocidental e Oeiras, Lisbon, Portugal6Nephrology Department, Hospital Garcia de Orta, Lisbon, Portugal7Faculty of Medicine, Instituto de Investigação e Inovação em Sau´de, University of Porto, Porto, PortugalCorresponding author: João Se´rgio Neves, joaosergioneves@gmail.com.© 2018 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for proﬁt,and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.See accompanying articles, pp. 1132, 1134, 1142, e84, e86, and e90.João Se´rgio Neves,1,2Miguel Bigotte Vieira,3 Lia Leitão,4Catarina Viegas Dias,5Rita Magriço,6Ana Isabel Oliveira,1 andDavide Carvalho1,7e88 Diabetes Care Volume 41, June 2018BLOODPRESSUREANDTYPE2DIABETES3. Eastwood SV, Tillin T, Sattar N, Forouhi NG,Hughes AD, Chaturvedi N. Associations betweenprediabetes, by three different diagnostic criteria,and incident CVD differ in South Asians and Euro-peans. Diabetes Care 2015;38:2325–23324. Huang Y, Cai X, MaiW, Li M, Hu Y. Associationbetween prediabetes and risk of cardiovasculardisease and all cause mortality: systematicreview and meta-analysis. BMJ 2016 23;355:i59535. Warren B, Pankow JS,Matsushita K, et al. Com-parative prognostic performance of deﬁnitions ofprediabetes: a prospective cohort analysis of theAtherosclerosis Risk in Communities (ARIC) study.Lancet Diabetes Endocrinol 2017;5:34–42care.diabetesjournals.org Comment e89

Comment on Bress et al. Effect of Intensive Versus Standard Blood Pressure Treatment According to Baseline Prediabetes Status: A Post Hoc Analysis of a Randomized Trial. Diabetes Care 2017;40:1401-1408.

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Comment on Bress et al. Effect of Intensive Versus Standard Blood Pressure Treatment According to Baseline Prediabetes Status: A Post Hoc Analysis of a Randomized Trial. Diabetes Care 2017;40:1401-1408.

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