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Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38
Stearne, M R; Palmer, S L; Hammersley, M S; Franklin, S L; Spivey, R S; Levy, J C; Tidy, C R; Bell, N J; Steemson, J; Barrow, B A; Coster, R; Waring, K; Nolan, J; Truscott, E; Walravens, N; Cook, L; Lampard, H; Merle, C; Parker, P; McVittie, J; Draisey, I; Murchison, L E; Brunt, A H E; Williams, M J; Pearson, D W; Petrie, X M P; Lean, M E J; Walmsley, D; Lyall, M J; Christie, E; Church, J; Thomson, E; Farrow, A; Stowers, J M; Stowers, M; McHardy, K; Patterson, N; Wright, A D; Levi, N A; Shearer, A C I; Thompson, R J W; Taylor, G; Rayton, S; Bradbury, M; Glover, A; Smyth-Osbourne, A; Parkes, C; Graham, J; England, P; Gyde, S; Eagle, C; Chakrabarti, B; Smith, J; Sherwell, J; Kohner, E M; Dornhurst, A; Doddridge, M C; Dumskyj, M; Walji, S; Sharp, P; Sleightholm, M; Vanterpool, G; Rose, C; Frost, G; Roseblade, M; Elliott, S; Forrester, S; Foster, M; Myers, K; Chapman, R; Hayes, J R; Henry, R W; Featherston, M S; Archbold, G P R; Copeland, M; Harper, R; Richardson, I; Martin, S; Foster, M; Davison, H A; Hadden, D R; Kennedy, L; Atkinson, A B; Culbert, A M; Hegan, C; Tennet, H; Webb, N; Robinson, I; Holmes, J; Foster, M; Bell, P M; McCance, D R; Rutherford, J; Nesbitt, S; Spathis, A S; Hyer, S; Nanson, M E; James, L M; Tyrell, J M; Davis, C; Strugnell, P; Booth, M; Petrie, H; Clark, D; Rice, B; Hulland, S; Barron, J L; Yudkin, J S; Gould, B J; Singer, J; Badenock, A; Walji, S; Eckert, M; Alibhai, K; Marriot, E; Cox, C; Price, R; Fernandez, M; Ryle, A; Clarke, S; Wallace, G; Mehmed, E; MacFarlane, S; Greenwood, R H; Wilson, J; Denholm, M J; Temple, R C; Whitfield, K; Johnson, F; Munroe, C; Gorick, S; Duckworth, E; Flatman, M; Rainbow, S; Borthwick, L J; Wheatcroft, D J; Seaman, R J; Christie, R A; Wheatcroft, W; Musk, P; White, J; McDougal, S; Bond, M; Raniga, P; Newton, R W; Jung, R T; Roxburgh, C; Kilgallon, B; Dick, L; Foster, M; Waugh, N; Kilby, S; Ellingford, A; Burns, J; Fox, C V; Holloway, M C; Coghill, H M; Hein, N; Fox, A; Cowan, W; Richard, M; Quested, K; Evans, S J; Paisey, R B; Brown, N P R; Tucker, A J; Paisey, R; Garrett, F; Hogg, J; Park, P; Williams, K; Harvey, P; Wilcocks, R; Mason, S; Frost, J; Warren, C; Rocket, P; Bower, L; Roland, J M; Brown, D J; Youens, J; Stanton-King, K; Mungall, H; Ball, V; Maddison, W; Donnelly, D; King, S; Griffin, P; Smith, S; Church, S; Dunn, G; Wilson, A; Palmer, K; Brown, P M; Humphriss, D; Davidson, A J M; Rose, R; Armistead, L; Townsend, S; Poon, P; Peacock, I D A; Culverwell, N J C; Charlton, M H; Connolly, B P S; Peacock, J; Barrett, J; Wain, J; Beeston, W; King, G; Hill, P G; Boulton, A J M; Robertson, A M; Katoulis, V; Olukoga, A; McDonald, H; Kumar, S; Abouaesha, F; Abuaisha, B; Knowles, E A; Higgins, S; Booker, J; Sunter, J; Breislin, K; Parker, R; Raval, P; Curwell, J; Davenport, H; Shawcross, G; Prest, A; Grey, J; Cole, H; Sereviratne, C; Young, R J; Dornan, T L; Clyne, J R; Gibson, M; O'Connell, I; Wong, L M; Wilson, S J; Wright, K L; Wallace, C; McDowell, D; Burden, A C; Sellen, E M; Gregory, R; Roshan, M; Vaghela, N; Burden, M; Sherriff, C; Clarke, J; Grenfell, J; Tooke, J E; MacLeod, K; Searnark, C; Rammell, M; Pym, C; Stockman, J; Yeo, C; Piper, J; Leighton, L; Green, E; Hoyle, M; Jones, K; Hudson, A; James, A J; Shore, A; Higham, A; Martin, B
British Medical Journal. 1998;317(7160):703-713.
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Abstract
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.
Bibliographic metadata
- Stearne, M R
- Palmer, S L
- Hammersley, M S
- Franklin, S L
- Spivey, R S
- Levy, J C
- Tidy, C R
- Bell, N J
- Steemson, J
- Barrow, B A
- Coster, R
- Waring, K
- Nolan, J
- Truscott, E
- Walravens, N
- Cook, L
- Lampard, H
- Merle, C
- Parker, P
- McVittie, J
- Draisey, I
- Murchison, L E
- Brunt, A H E
- Williams, M J
- Pearson, D W
- Petrie, X M P
- Lean, M E J
- Walmsley, D
- Lyall, M J
- Christie, E
- Church, J
- Thomson, E
- Farrow, A
- Stowers, J M
- Stowers, M
- McHardy, K
- Patterson, N
- Wright, A D
- Levi, N A
- Shearer, A C I
- Thompson, R J W
- Taylor, G
- Rayton, S
- Bradbury, M
- Glover, A
- Smyth-Osbourne, A
- Parkes, C
- Graham, J
- England, P
- Gyde, S
- Eagle, C
- Chakrabarti, B
- Smith, J
- Sherwell, J
- Kohner, E M
- Dornhurst, A
- Doddridge, M C
- Dumskyj, M
- Walji, S
- Sharp, P
- Sleightholm, M
- Vanterpool, G
- Rose, C
- Frost, G
- Roseblade, M
- Elliott, S
- Forrester, S
- Foster, M
- Myers, K
- Chapman, R
- Hayes, J R
- Henry, R W
- Featherston, M S
- Archbold, G P R
- Copeland, M
- Harper, R
- Richardson, I
- Martin, S
- Foster, M
- Davison, H A
- Hadden, D R
- Kennedy, L
- Atkinson, A B
- Culbert, A M
- Hegan, C
- Tennet, H
- Webb, N
- Robinson, I
- Holmes, J
- Foster, M
- Bell, P M
- McCance, D R
- Rutherford, J
- Nesbitt, S
- Spathis, A S
- Hyer, S
- Nanson, M E
- James, L M
- Tyrell, J M
- Davis, C
- Strugnell, P
- Booth, M
- Petrie, H
- Clark, D
- Rice, B
- Hulland, S
- Barron, J L
- Yudkin, J S
- Gould, B J
- Singer, J
- Badenock, A
- Walji, S
- Eckert, M
- Alibhai, K
- Marriot, E
- Cox, C
- Price, R
- Fernandez, M
- Ryle, A
- Clarke, S
- Wallace, G
- Mehmed, E
- MacFarlane, S
- Greenwood, R H
- Wilson, J
- Denholm, M J
- Temple, R C
- Whitfield, K
- Johnson, F
- Munroe, C
- Gorick, S
- Duckworth, E
- Flatman, M
- Rainbow, S
- Borthwick, L J
- Wheatcroft, D J
- Seaman, R J
- Christie, R A
- Wheatcroft, W
- Musk, P
- White, J
- McDougal, S
- Bond, M
- Raniga, P
- Newton, R W
- Jung, R T
- Roxburgh, C
- Kilgallon, B
- Dick, L
- Foster, M
- Waugh, N
- Kilby, S
- Ellingford, A
- Burns, J
- Fox, C V
- Holloway, M C
- Coghill, H M
- Hein, N
- Fox, A
- Cowan, W
- Richard, M
- Quested, K
- Evans, S J
- Paisey, R B
- Brown, N P R
- Tucker, A J
- Paisey, R
- Garrett, F
- Hogg, J
- Park, P
- Williams, K
- Harvey, P
- Wilcocks, R
- Mason, S
- Frost, J
- Warren, C
- Rocket, P
- Bower, L
- Roland, J M
- Brown, D J
- Youens, J
- Stanton-King, K
- Mungall, H
- Ball, V
- Maddison, W
- Donnelly, D
- King, S
- Griffin, P
- Smith, S
- Church, S
- Dunn, G
- Wilson, A
- Palmer, K
- Brown, P M
- Humphriss, D
- Davidson, A J M
- Rose, R
- Armistead, L
- Townsend, S
- Poon, P
- Peacock, I D A
- Culverwell, N J C
- Charlton, M H
- Connolly, B P S
- Peacock, J
- Barrett, J
- Wain, J
- Beeston, W
- King, G
- Hill, P G
- Boulton, A J M
- Robertson, A M
- Katoulis, V
- Olukoga, A
- McDonald, H
- Kumar, S
- Abouaesha, F
- Abuaisha, B
- Knowles, E A
- Higgins, S
- Booker, J
- Sunter, J
- Breislin, K
- Parker, R
- Raval, P
- Curwell, J
- Davenport, H
- Shawcross, G
- Prest, A
- Grey, J
- Cole, H
- Sereviratne, C
- Young, R J
- Dornan, T L
- Clyne, J R
- Gibson, M
- O'Connell, I
- Wong, L M
- Wilson, S J
- Wright, K L
- Wallace, C
- McDowell, D
- Burden, A C
- Sellen, E M
- Gregory, R
- Roshan, M
- Vaghela, N
- Burden, M
- Sherriff, C
- Clarke, J
- Grenfell, J
- Tooke, J E
- MacLeod, K
- Searnark, C
- Rammell, M
- Pym, C
- Stockman, J
- Yeo, C
- Piper, J
- Leighton, L
- Green, E
- Hoyle, M
- Jones, K
- Hudson, A
- James, A J
- Shore, A
- Higham, A
- Martin, B
- Related website <Go to ISI>://000075995100018