The associations between BP-lowering treatments and outcomes were not significantly different , irrespective of drug class , except for stroke and heart failure .
AND RELEVANCE Among patients with type 2 diabetes , BP lowering was associated with improved mortality and other clinical outcomes with lower RRs observed among those with baseline BP of 140 mm Hg and greater .
These findings support the use of medications for BP lowering in these patients
IMPORTANCE Lowering blood pressure ( BP ) is widely used to reduce vascular risk in individuals with diabetes .
OBJECTIVE To determine the associations between BP-lowering treatment and vascular disease in type 2 diabetes .
Effect of candesartan on progression and regression of retinopathy in type 2 diabetes (DIRECT-Protect 2): a randomised placebo-controlled trial
BACKGROUND Diabetic retinopathy remains a leading cause of visual loss in people of working age . We examined whether c and esartan treatment could slow the progression and , secondly , induce regression of retinopathy in people with type 2 diabetes . METHODS We did a r and omised , double-blind , parallel-group , placebo-controlled trial in 309 centres worldwide . We recruited normoalbuminuric , normotensive , or treated hypertensive people with type 2 diabetes with mild to moderately severe retinopathy and assigned them to c and esartan 16 mg once a day or placebo . After a month , the dose was doubled to 32 mg once per day . Investigators and patients were unaware of the treatment allocation status . Progression of retinopathy was the primary endpoint , and regression was a secondary endpoint . Analysis was by intention to treat . The trial is registered with Clinical Trials.gov , number NCT00252694 . FINDINGS 1905 participants ( aged 37 - 75 years ) were r and omised to c and esartan ( n=951 ) or placebo ( n=954 ) . 161 ( 17 % ) patients in the c and esartan group and 182 ( 19 % ) in the placebo group had progression of retinopathy by three steps or more on the Early Treatment Diabetic Retinopathy Study scale . The risk of progression of retinopathy was non-significantly reduced by 13 % in patients on c and esartan compared with those on placebo ( hazard ratio [ HR ] 0.87 , 95 % CI 0.70 - 1.08 , p=0.20 ) . Regression on active treatment was increased by 34 % ( 1.34 , 1.08 - 1.68 , p=0.009 ) . HRs were not attenuated by adjustment for baseline risk factors or changes in blood pressure during the trial . An overall change towards less severe retinopathy by the end of the trial was observed in the c and esartan group ( odds 1.17 , 95 % CI 1.05 - 1.30 , p=0.003 ) . Adverse events did not differ between the treatment groups . INTERPRETATION Treatment with c and esartan in type 2 diabetic patients with mild to moderate retinopathy might induce improvement of retinopathy
The associations between BP-lowering treatments and outcomes were not significantly different , irrespective of drug class , except for stroke and heart failure .
AND RELEVANCE Among patients with type 2 diabetes , BP lowering was associated with improved mortality and other clinical outcomes with lower RRs observed among those with baseline BP of 140 mm Hg and greater .
These findings support the use of medications for BP lowering in these patients
IMPORTANCE Lowering blood pressure ( BP ) is widely used to reduce vascular risk in individuals with diabetes .
OBJECTIVE To determine the associations between BP-lowering treatment and vascular disease in type 2 diabetes .