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UK Prospective Diabetes Study Group Correspondence to: Professor R
Turner, UK Prospective Diabetes Study Group, Diabetes Research
Laboratories, Radcliffe Infirmary, Oxford OX2
6HE
Objective: To determine whether tight control of
blood pressure prevents macrovascular and microvascular complications in patients with type 2 diabetes.
Design: Randomised controlled trial comparing tight
control of blood pressure aiming at a blood pressure of
<150/85 mm Hg (with the use of an angiotensin converting enzyme
inhibitor captopril or a
blocker atenolol as main treatment) with
less tight control aiming at a blood pressure of <180/105 mm Hg.
Setting: 20 hospital based clinics in England,
Scotland, and Northern Ireland.
Subjects: 1148 hypertensive patients with type 2 diabetes (mean age 56, mean blood pressure at entry 160/94 mm Hg); 758 patients were allocated to tight control of blood pressure and 390 patients to less tight control with a median follow up of 8.4 years.
Main outcome measures: Predefined clinical end
points, fatal and non-fatal, related to diabetes, deaths related to diabetes, and all cause mortality. Surrogate measures of microvascular disease included urinary albumin excretion and retinal photography.
Results: Mean blood pressure during follow up was
significantly reduced in the group assigned tight blood pressure control (144/82 mm Hg) compared with the group assigned to less tight
control (154/87 mm Hg) (P<0.0001). Reductions in risk in the group
assigned to tight control compared with that assigned to less tight
control were 24% in diabetes related end points (95% confidence
interval 8% to 38%) (P=0.0046), 32% in deaths related to diabetes
(6% to 51%) (P=0.019), 44% in strokes (11% to 65%) (P=0.013), and
37% in microvascular end points (11% to 56%) (P=0.0092),
predominantly owing to a reduced risk of retinal photocoagulation.
There was a non-significant reduction in all cause mortality. After
nine years of follow up the group assigned to tight blood pressure
control also had a 34% reduction in risk in the proportion of patients
with deterioration of retinopathy by two steps (99% confidence
interval 11% to 50%) (P=0.0004) and a 47% reduced risk (7% to 70%)
(P=0.004) of deterioration in visual acuity by three lines of the early
treatment of diabetic retinopathy study (ETDRS) chart. After nine years
of follow up 29% of patients in the group assigned to tight control
required three or more treatments to lower blood pressure to achieve
target blood pressures.
Conclusion: Tight blood pressure control in patients
with hypertension and type 2 diabetes achieves a clinically important reduction in the risk of deaths related to diabetes, complications related to diabetes, progression of diabetic retinopathy, and deterioration in visual acuity.
Key messages
© BMJ 1998
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