Please select the eligibility criteria that correspond to the clinical trial below.
Title: Blood Pressure Control Target in Diabetes (BPROAD): a Multicenter, Open-label, Parallel-group, Randomized Controlled Trial
Brief Summary: This is a multicenter, open-label, parallel-group, randomized controlled trial that will be conducted across mainland China. This trial will test the primary hypothesis of whether an intensive treatment strategy (a systolic blood pressure target of \<120 mmHg) is more effective than a standard treatment strategy (a systolic blood pressure target of \<140 mmHg) in reducing the risk of major cardiovascular disease (non-fatal stroke, non-fatal myocardial infarction, treated or hospitalized heart failure, and cardiovascular deaths) over a follow-up period of up to 5 years among patients with a history of diabetes and elevated systolic blood pressure. The secondary hypotheses are to compare the intensive blood pressure treatment strategy with the standard treatment strategy on cognitive function, individual components of the primary hypothesis, all-cause mortality, kidney outcomes, quality of life, and injurious falls, et al.


Options:
A: Inclusion Criteria:

1. Men and women aged ≥50 years;
2. Diabetes defined as:

   * A self-reported previous diagnosis by health care professionals and taking anti-diabetic medications;
   * Fasting plasma glucose level of ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 hours;
   * 2-hour plasma glucose level of ≥200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test. The test should be performed using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water; or
   * HbA1c concentration of ≥6.5% (48 mmol/mol);
3. Systolic blood pressure

   -≥140 mmHg on 0 medication;
   * 130-180 mmHg on 1 medication;
   * 130-170 mmHg on up to 2 medications;
   * 130-160 mmHg on up to 3 medications; or
   * 130-150 mmHg on up to 4 medications;
4. Increased risk of cardiovascular disease (one or more of the following):

   * Previous history of clinical CVD (≥ 3 months)
   * Subclinical CVD within 3 years
   * 2 or more CVD risk factors
   * Estimated glomerular filtration rate (eGFR) 30-59 ml/min/1.73 m2

Exclusion Criteria:

1. History consistent with type 1 diabetes
2. Known secondary cause of hypertension
3. One minute standing systolic BP \<110 mmHg
4. Arm circumference too large to allow accurate blood pressure measurement with available devices
5. Cardiovascular event or procedure or hospitalization for unstable angina within the past 3 months
6. Symptomatic heart failure within the past 6 months or left ventricular ejection fraction (by any method) \<35% within the past 6 months
7. ALT or AST levels more than twice the upper limit of the normal range or active liver diseases
8. Dialysis, kidney transplantation, eGFR \<30 ml/min/1.73 m2, or serum creatinine \>2.0 mg/dl
9. Proteinuria
10. Previous diagnosis of polycystic kidney disease or glomerulonephritis
11. A medical condition likely to limit survival to less than 5 years
12. Any factors judged by the clinic team to be likely to limit adherence to interventions
13. Failure to obtain informed consent from participant
14. Currently participating in another intervention study
15. Currently living with another BPROAD participant
16. Pregnancy, currently trying to become pregnant, or of child-bearing potential and not using birth control
B: Inclusion Criteria:

* Diagnosed with type 2 diabetes mellitus, as determined by the new American Diabetes Association guidelines, which include a fasting plasma glucose level greater than 126 mg/dl (7.0 mmol/l), or a 2-hour postload value in the oral glucose tolerance test of greater than 200 mg/dl, with confirmation by a retest
* For participants aged 40 years or older, history of CVD (heart attack, stroke, history of coronary revascularization, history of peripheral or carotid revascularization, or demonstrated angina)
* For participants aged 55 years or older, a history of CVD is not required, but participant must be considered to be at high risk for experiencing a CVD event due to existing CVD, subclinical disease, or 2+ CVD risk factors
* HbA1c 7.5%-9% (if on more drugs) or 7.5%-11% (if on fewer drugs)
C: Inclusion Criteria:

* Male or female
* Age 50 to no upper limit
* Hypertension documented according to the 6th report of the Joint National Committee on Detection and Evaluation of the treatment of high BP (JNC VI) and the need for drug therapy (previously documented hypertension in patients currently taking antihypertensive agents is acceptable)
* Documented CAD (e.g., classic angina pectoris (stable angina pectoris; Heberden angina pectoris), myocardial infarction three or more months ago, abnormal coronary angiography, or concordant abnormalities on two different types of stress tests)
* Willingness to sign informed consent

Exclusion Criteria:

* Unstable angina, angioplasty, coronary artery bypass graft surgery (CABG) or stroke within one month. Patients taking beta blockers after myocardial infarction are excluded if study enrollment is planned within 12 months of myocardial infarction. No time limitation if not taking beta-blocker.
* Use of a ß-blocker within past two weeks
* Patients without a pacemaker and any of the following:

  * Sinus bradycardia (\< 50 beats/min.)
  * Sick sinus syndrome
  * Atrioventricular (AV)-block of more than 1st degree
* Documented contraindication to verapamil; documented contraindication to both atenolol and hydrochlorothiazide
* Atrial fibrillation/flutter with Wolff-Parkinson-White (WPW)-Syndrome
* Severe heart failure (New York Heart Association \[NYHA\] IV).
* Concomitant illnesses (e.g., severe renal failure \[Serum creatinine ≥4.0 mg/dl\], severe hepatic failure or known cirrhosis, etc.) which may affect outcome variables or where life expectancy is two years or less or which are likely to require frequent hospitalizations and/or treatment adjustments.
* Patients with psychiatric, cognitive, or social (e.g., alcoholism, etc.) conditions that would interfere with giving consent or cooperating or remaining available for follow-up for two years.
D: Inclusion Criteria:

1. Systolic BP between 140-190 mm Hg in the three screening visits or currently under anti-hypertension treatment；
2. An age of 60 - 80 years old；
3. Signed the written informed consent.

Exclusion Criteria:

1. Systolic BP≥190 mm Hg, or diastolic BP \<60 mm Hg;
2. Known secondary cause of hypertension;
3. History of large atherosclerotic cerebral infarction or hemorrhagic stroke (not lacunar infarction and transient ischemic attack \[TIA\]);
4. Hospitalization for myocardial infarction or unstable angina within the previous 6 months;
5. Coronary revascularization (PCI or CABG) within the previous 12 months;
6. Planned to perform coronary revascularization (PCI or CABG) in the future 12 months;
7. History of sustained atrial fibrillation or Ventricular arrhythmias at entry influencing the measurement of electronic blood pressure；
8. NYHA class III-IV heart failure at entry or hospitalization for exacerbation of chronic heart failure within the previous 6 months;
9. Severe valvular disease or valvular disease likely to require surgery or percutaneous valve replacement during the trial;
10. Dilated or hypertrophic cardiomyopathy, rheumatic heart disease, or congenital heart disease;
11. Uncontrolled diabetes (serum fasting glucose ≥200 mg/dl \[11.1 mmol/L\], HbA1\>8%);
12. Lab tests indicating abnormal liver or kidney function (ALT more than 3 times the upper limit of normal value, or end stage renal disease (ESRD) on dialysis, or estimated glomerular filtration rate (eGFR) \<30 mL/min, or serum creatine \>2.5 mg/dl \[\>221 umol/L\];
13. Severe somatic disease such as cancer;
14. Severe cognitive impairment or mental disorders;
15. Participating in other clinical trials.

Answer: A