Stearne, MR; Palmer, SL; Hammersley, MS; Franklin, SL; Spivey, RS; Levy, JC; ... US Prospective Diabetes Study Grp,; + view all Stearne, MR; Palmer, SL; Hammersley, MS; Franklin, SL; Spivey, RS; Levy, JC; Tidy, CR; Bell, NJ; Steemson, J; Barrow, BA; Coster, R; Waring, K; Nolan, J; Truscott, E; Walravens, N; Cook, L; Lampard, H; Merle, C; Parker, P; McVittie, J; Draisey, I; Murchison, LE; Brunt, AHE; Williams, MJ; Pearson, DW; Petrie, XMP; Lean, MEJ; Walmsley, D; Lyall, MJ; Christie, E; Church, J; Thomson, E; Farrow, A; Stowers, JM; Stowers, M; McHardy, K; Patterson, N; Wright, AD; Levi, NA; Shearer, ACI; Thompson, RJW; 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, EM; Dornhurst, A; Doddridge, MC; 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, JR; Henry, RW; Featherston, MS; Archbold, GPR; Copeland, M; Harper, R; Richardson, I; Martin, S; Foster, M; Davison, HA; Hadden, DR; Kennedy, L; Atkinson, AB; Culbert, AM; Hegan, C; Tennet, H; Webb, N; Robinson, I; Holmes, J; Foster, M; Bell, PM; McCance, DR; Rutherford, J; Nesbitt, S; Spathis, AS; Hyer, S; Nanson, ME; James, LM; Tyrell, JM; Davis, C; Strugnell, P; Booth, M; Petrie, H; Clark, D; Rice, B; Hulland, S; Barron, JL; Yudkin, JS; Gould, BJ; 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, RH; Wilson, J; Denholm, MJ; Temple, RC; Whitfield, K; Johnson, F; Munroe, C; Gorick, S; Duckworth, E; Flatman, M; Rainbow, S; Borthwick, LJ; Wheatcroft, DJ; Seaman, RJ; Christie, RA; Wheatcroft, W; Musk, P; White, J; McDougal, S; Bond, M; Raniga, P; Newton, RW; Jung, RT; Roxburgh, C; Kilgallon, B; Dick, L; Foster, M; Waugh, N; Kilby, S; Ellingford, A; Burns, J; Fox, CV; Holloway, MC; Coghill, HM; Hein, N; Fox, A; Cowan, W; Richard, M; Quested, K; Evans, SJ; Paisey, RB; Brown, NPR; Tucker, AJ; 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, JM; Brown, DJ; 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, PM; Humphriss, D; Davidson, AJM; Rose, R; Armistead, L; Townsend, S; Poon, P; Peacock, IDA; Culverwell, NJC; Charlton, MH; Connolly, BPS; Peacock, J; Barrett, J; Wain, J; Beeston, W; King, G; Hill, PG; Boulton, AJM; Robertson, AM; Katoulis, V; Olukoga, A; McDonald, H; Kumar, S; Abouaesha, F; Abuaisha, B; Knowles, EA; 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, RJ; Dornan, TL; Clyne, JR; Gibson, M; O'Connell, I; Wong, LM; Wilson, SJ; Wright, KL; Wallace, C; McDowell, D; Burden, AC; Sellen, EM; Gregory, R; Roshan, M; Vaghela, N; Burden, M; Sherriff, C; Clarke, J; Grenfell, J; Tooke, JE; 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, AJ; Shore, A; Higham, A; Martin, B; US Prospective Diabetes Study Grp,; - view fewer (1998) Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BRIT MED J , 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.
|Title:||Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38|
|Keywords:||CORONARY HEART-DISEASE, STAGE RENAL-DISEASE, ANTIHYPERTENSIVE TREATMENT, HYPERTENSION, MELLITUS, MORTALITY, STROKE, MORBIDITY, TRIAL, MEN|
|UCL classification:||UCL > School of Life and Medical Sciences|
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