Record 1 of 1 - MEDLINE EXPRESS (R) 1996-1998

TI: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group [see comments]

CM: Comment in: BMJ 1998 Sep 12;317(7160):691-2. Comment in: BMJ 1998 Sep 12;317(7160):693-4

SO: BMJ. 1998 Sep 12; 317(7160): 703-13

ISSN: 0959-8138

PY: 1998

LA: ENGLISH

CP: ENGLAND

AB: 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 beta 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.

MESH: Albuminuria-etiology; Blood-Glucose-metabolism; Cerebrovascular-Disorders-prevention-and-control; Diabetic-Angiopathies-physiopathology; Diabetic-Retinopathy-prevention-and-control; Follow-Up-Studies; Hypoglycemia-etiology; Middle-Age; Myocardial-Infarction-prevention-and-control; Patient-Compliance; Peripheral-Vascular-Diseases-prevention-and-control; Prospective-Studies; Proteinuria-etiology; Visual-Acuity; Weight-Gain-drug-effects

MESH: *Adrenergic-beta-Antagonists-therapeutic-use; *Angiotensin-Converting-Enzyme-Inhibitors-therapeutic-use; *Antihypertensive-Agents-therapeutic-use; *Atenolol-therapeutic-use; *Captopril-therapeutic-use; *Diabetes-Mellitus,-Non-Insulin-Dependent-complications; *Diabetic-Angiopathies-prevention-and-control; *Hypertension-prevention-and-control

TG: Comparative-Study; Female; Human; Male; Support,-Non-U.S.-Gov't; Support,-U.S.-Gov't,-P.H.S.

PT: CLINICAL-TRIAL; JOURNAL-ARTICLE; MULTICENTER-STUDY; RANDOMIZED-CONTROLLED-TRIAL

RN: 0; 0; 0; 0; 29122-68-7; 62571-86-2

NM: Adrenergic-beta-Antagonists; Angiotensin-Converting-Enzyme-Inhibitors; Antihypertensive-Agents; Blood-Glucose; Atenolol; Captopril

AN: 1998404064

UD: 199901

SB: AIM