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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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.

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Created by:
Gibson, Martin
15th January, 2012, 15:04:13
Last modified by:
Gibson, Martin
Last modified:
1st February, 2013, 19:47:07

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