ukpds

UKPDS 38:

To determine whether tight control of blood pressure prevents macrovascular & microvascular complications in patients with type 2
diabetes. 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. 20 hospital based clinics in England, Scotland, & Northern Ireland. 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 & 390 to less tight control with a median

follow up of 8.4 years. Predefined clinical end points, fatal & non-fatal, related to diabetes, deaths related to diabetes, & all cause mortality. Surrogate

measures of microvascular disease included urinary albumin excretion & retinal photography. 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), & 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) & 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 9 years of follow up 29% of patients in the group assigned to tight control required 3 or more treatments to lower blood pressure to achieve target

blood pressures.

CONCLUSIONS : Tight blood pressure control in patients with hypertension & type 2 diabetes achieves a clinically important
reduction in the risk of deaths related to diabetes, complications related to diabetes, progression of diabetic retinopathy & deterioration in visual acuity