Optimal Blood Pressure for the prevenTIon of Major vAscuLar Events in Patients With DIABETES Mellitus (OPTIMAL-DIABETES)
Diabetes Mellitus, High Blood Pressure, Cardiovascular Diseases
About this trial
This is an interventional treatment trial for Diabetes Mellitus
Eligibility Criteria
Inclusion Criteria:
Systolic Blood Pressure (SBP) between 130 and 180 mm Hg:
- 130 to 150 mm Hg (if on 0-4 medications)
- 130 to 160 mm Hg (if on 0-3 medications)
- 130 to 170 mm Hg (if on 0-2 medications)
- 130 to 180 mm Hg (if on 0-1 medications)
- Type 2 diabetes
To be considered as having a high cardiovascular risk, including AT LEAST ONE of the following factors:
Established cardiovascular disease (CVD), including:
- Coronary artery disease: previous myocardial infarction, previous acute coronary syndrome, previous percutaneous coronary intervention, previous coronary artery bypass graft surgery, or at least 50% stenosis in a main coronary artery associated with typical angina pectoris; or
- Cerebrovascular disease: previous stroke (except those events caused by intracranial aneurysm or arteriovenous malformation) or previous transient ischemic attack (TIA), stable for at least 2 weeks preceding inclusion in the study; or
- Carotid artery disease: previous carotid endarterectomy, previous percutaneous intervention with carotid stent implantation, or stenosis of at least 50% in a carotid shown by the Doppler ultrasonography, CT angiography or MR angiography; or
- Peripheral artery disease: prior surgical or percutaneous revascularization of a peripheral artery, limb amputation due to vascular cause, abdominal aortic aneurysm ≥ 5 cm (with or without prior surgical or percutaneous repair), or stenosis of at least 50% in a peripheral artery associated to intermittent claudication.
Subclinical CVD, including:
- Coronary calcium score ≥ 300 Agatston units; or
- Ankle-brachial index ≤ 0.90 in the last two years; or
- Left ventricular hypertrophy on the electrocardiogram, echocardiogram or other cardiac imaging exam in the last two years.
Chronic kidney disease (CKD):
▪ Definition of CKD: glomerular filtration rate (GFR) between 20 and 59 ml/min/1.73m2 calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI).
Additional cardiovascular risk factors, including:
- Active smoking: Defined as regular use of cigarettes or other tobacco products, such as cigars and pipe, in the last six months;
- Dyslipidemia: Defined as LDL cholesterol > 70 mg/dL or non-HDL cholesterol > 100 mg/dL in patients with previous CVD; or LDL cholesterol > 100 mg/dL or non-HDL cholesterol > 130 mg/dL in patients without previous CVD; or Triglycerides > 200 mg/dL or HDL < 40 mg/dL regardless of treatment; or use of statins or other lipid lowering medication; or
- Age ≥ 75 years
Exclusion Criteria:
- Refusal to provide written informed consent
- Body mass index > 45 kg/m2
- Known secondary cause of hypertension
- Severe renal dysfunction with GFR < 20 mL/min/1.73m2 calculated by the CKD-EPI equation
- Angina at rest Class IV Canadian Cardiovascular Society (CCS)
- Acute coronary syndrome in the last six months
- Symptomatic heart failure Class IV New York Heart Association (NYHA) or ejection fraction < 35% on Doppler echocardiography in the last six months
Factors that at the research team´s judgment may limit adherence to the intervention and study protocol, including, but not limited to, the following examples:
- Recent history of alcohol and illicit drug abuse
- Psychiatric comorbidities (severe depression, schizophrenia, psychosis, etc.)
- History of poor medication adherence and attendance to consultations
- Any plans to move the city of residence in the next four years
- Any plans to leave the city of residence for more than three months in the next few years
- Living in the same residence of another patient previously included in this study
- Patients currently enrolled in another study for CVD prevention, including those evaluating pharmacological and non-pharmacological interventions
- Pregnancy or breastfeeding
Sites / Locations
- Centro de Pesquisas Clínicas Dr Marco Mota
- Centro de Pesquisas em Diabetes e Doenças Endocrino-Metabólicas
- Hospital Ana Nery
- Instituto de Estudos E Pesquisas Clinicas Do Ceara
- Instituto Hospital de Base
- Hospital Universitário Cassiano Antonio de Moraes
- Universidade Federal de Goiás
- NS Clínica de Diabetes e Endocrinologia Ltda
- Hospital das Clinicas da Universidade Federal de Minas Gerais
- Centro de Pesquisa do Hospital Santa Lúcia
- Medicina Nuclear Alto da XV
- Hospital Universitário João de Barros Barreto - UFPA
- Pronto Socorro Cardiológico de Pernambuco Prof. Luiz Tavares da Silva
- Hospital de Clínicas de Porto Alegre
- Hospital São Lucas da PUCRS
- Centro de Pesquisa Clínica do Coração
- Centro de Endocrinologia Geloneze
- Universidade Estadual de Campinas - UNICAMP
- Indacor Servicos Medicos Ltda
- Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo
- Centro Integrado de Pesquisas
- Clínica Vilela & Martin
- Instituto de Cardiologia e Endocrinologia Rio Preto Ltda
- Clínica Cardiológica
- Santa Casa de Misericordia de Votuporanga
- Faculdade de Ciências Médicas - Universidade do Estado do Rio de Janeiro
- Clínica de Metabologia e Hipertensão da Universidade Federal de São Paulo
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
- Instituto Dante Pazzanese de Cardiologia
- Irmandade Da Santa Casa de Misericordia de Sao Paulo
- Real e Benemérita Associação Portuguesa de Beneficência/SP
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Intensive Control of Systolic Blood Pressure (SBP)
Standard Control of Systolic Blood Pressure (SBP)
Participants randomized into the Intensive Blood Pressure arm will have a goal of SBP <120 mm Hg.
Participants randomized into the Standard arm will have a goal of SBP <140 mm Hg.