Tight blood pressure control reduces risks of type 2 diabetes and is cost effective

Many patients with type 2 diabetes have hypertension. In three reports the United Kingdom Prospective Diabetes Study Group shows, firstly, that in hypertensive patients with type 2 diabetes tight control of blood pressure (mean 144/82 mm Hg over nine years, compared with 154/87 mm Hg in controls) resulted in a 24% reduction in any diabetic complications (macrovascular and microvascular) and a 32% reduction in death related to diabetes (mostly from myocardial infarction and strokes) (p 703). In the second study (p 713) an angiotensin converting enzyme inhibitor (captopril) and a  blocker (atenolol) were equally effective in reducing blood pressure and the risk of clinical end points and of progression of retinopathy. By nine years a quarter of the patients required three or more blood pressure lowering treatments. These results suggest that lowering blood pressure in itself may be important in reducing the complications of type 2 diabetes rather than the treatment used. The final report (p 720) shows that tight control of blood pressure is cost effective and comparable with other widely supported preventive strategies.

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