ACCORD

ACCORD^? : Action to Control Cardiovascular Risk in Diabetes.

Abstract

Une cohorte de 4733 patients diabétiques de type 2 ont été randomisés pour un traitement intensif ciblant une PAS^? <120 mmHg ou un traitement usuel ciblant une PAS < 140 mmHg. Le critère de jugement principal était un critère combiné, associant décès cardiovasculaire, IDM^? et AVC^? non fatals. Après 1 an, la PAS moyennée était 119,3 mmHg dans le groupe intensif et 133,5 mmHg dans le groupe usuel. L’incidence^? annuelle du critère principal était 1,87% dans le groupe intensif et 2,09 dans le groupe usuel (HR^? 0,88 [CI], 0.73 - 1.06 ; P=0.20). L’incidence annuelle de décès de toutes causes était de 1,28% et 1,19% (hazard ratio, 1.07 ; 95% CI, 0.85 - 1.35 ; P=0.55). L’incidence annuelle d’AVC, un critère pré-spécifié était de 0,32% et 0,53% (hazard ratio, 0.59 ; 95% CI, 0.39 - 0.89 ; P=0.01). Des effets indésirables graves sont survenus chez 3,3% des patients dans le groupe intensif et 1,3% dans le groupe usuel.
Chez les patients diabétiques de type 2, l’intensification du traitement antihypertenseur ne modifie pas la mortalité et la morbidité cardiovasculaire, à l’exception d’une réduction significative des AVC au prix d’une moins bonne tolérance.

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