CONCLUSIONS Antihypertensive treatment reduces the risk of mortality and cardiovascular morbidity in people with diabetes mellitus and a systolic blood pressure more than 140 mm Hg .
If systolic blood pressure is less than 140 mm Hg , however , further treatment is associated with an increased risk of cardiovascular death , with no observed benefit
OBJECTIVE To assess the effect of antihypertensive treatment on mortality and cardiovascular morbidity in people with diabetes mellitus , at different blood pressure levels .
Low-dose ramipril reduces microalbuminuria in type 1 diabetic patients without hypertension: results of a randomized controlled trial.
OBJECTIVE To assess if low ( 1.25 mg ) and /or st and ard ( 5 mg ) doses of the ACE inhibitor ramipril could prevent progression of microalbuminuria ( incipient diabetic nephropathy ) in normotensive type 1 diabetic patients . RESEARCH DESIGN AND METHODS This study , using a multicenter r and omized placebo-controlled double-blind parallel group , was conducted over 2 years in 28 outpatient diabetic clinics in the U.K. and Irel and . We screened 334 type 1 diabetic patients with suspected microalbuminuria and normal blood pressure ; of these , 140 patients 18 - 65 years of age with a diagnosis of type 1 diabetes and persistent microalbuminuria , defined as urinary albumin excretion rate ( AER ) of 20 - 200 microg/min , were enrolled in the study . RESULTS The proportion of patients progressing to macroalbuminuria was reduced in the ramipril groups but did not reach statistical significance over 2 years . AER was significantly lower at year 2 in the combined ramipril-treated patients versus placebo ( P = 0.013 ) . More patients on ramipril regressed to normoalbuminuria ( < 20 microg/min ) , with 11 % for 1.25 mg ramipril , 20 % for 5 mg ramipril , and 4 % for placebo ( P = 0.053 ) . Blood pressure was significantly reduced to a similar extent with both 1.25 and 5 mg ramipril . Supine systolic blood pressure increased from 130 to 134 mmHg in the placebo group and fell in the 1.25 mg ramipril group ( from 132 to 129 mmHg ) and in the 5 mg ramipril group ( from 134 to 130 mmHg ) ( P = 0.003 , compared with placebo ) . No statistically significant changes were observed in glomerular filtration rate ( GFR ) between the placebo- and ramipril-treated groups during the 2-year period . CONCLUSIONS Microalbuminuria is reduced significantly by ramipril treatment in type 1 diabetic patients without hypertension . Although the magnitude of the response was greater , there is no significant difference between responses to 1.25 or 5 mg ramipril . Small but highly significant reductions in systolic and mean arterial pressures occur in ramipril-treated patients . GFR is stable at this stage of the evolution of diabetic nephropathy and is unaffected by ramipril treatment for 2 years
CONCLUSIONS Antihypertensive treatment reduces the risk of mortality and cardiovascular morbidity in people with diabetes mellitus and a systolic blood pressure more than 140 mm Hg .
If systolic blood pressure is less than 140 mm Hg , however , further treatment is associated with an increased risk of cardiovascular death , with no observed benefit
OBJECTIVE To assess the effect of antihypertensive treatment on mortality and cardiovascular morbidity in people with diabetes mellitus , at different blood pressure levels .