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 .
Effects of medical therapies on retinopathy progression in type 2 diabetes.
BACKGROUND We investigated whether intensive glycemic control , combination therapy for dyslipidemia , and intensive blood-pressure control would limit the progression of diabetic retinopathy in persons with type 2 diabetes . Previous data suggest that these systemic factors may be important in the development and progression of diabetic retinopathy . METHODS In a r and omized trial , we enrolled 10,251 participants with type 2 diabetes who were at high risk for cardiovascular disease to receive either intensive or st and ard treatment for glycemia ( target glycated hemoglobin level , < 6.0 % or 7.0 to 7.9 % , respectively ) and also for dyslipidemia ( 160 mg daily of fenofibrate plus simvastatin or placebo plus simvastatin ) or for systolic blood-pressure control ( target , < 120 or < 140 mm Hg ) . A subgroup of 2856 participants was evaluated for the effects of these interventions at 4 years on the progression of diabetic retinopathy by 3 or more steps on the Early Treatment Diabetic Retinopathy Study Severity Scale ( as assessed from seven-field stereoscopic fundus photographs , with 17 possible steps and a higher number of steps indicating greater severity ) or the development of diabetic retinopathy necessitating laser photocoagulation or vitrectomy . RESULTS At 4 years , the rates of progression of diabetic retinopathy were 7.3 % with intensive glycemia treatment , versus 10.4 % with st and ard therapy ( adjusted odds ratio , 0.67 ; 95 % confidence interval [ CI ] , 0.51 to 0.87 ; P=0.003 ) ; 6.5 % with fenofibrate for intensive dyslipidemia therapy , versus 10.2 % with placebo ( adjusted odds ratio , 0.60 ; 95 % CI , 0.42 to 0.87 ; P=0.006 ) ; and 10.4 % with intensive blood-pressure therapy , versus 8.8 % with st and ard therapy ( adjusted odds ratio , 1.23 ; 95 % CI , 0.84 to 1.79 ; P=0.29 ) . CONCLUSIONS Intensive glycemic control and intensive combination treatment of dyslipidemia , but not intensive blood-pressure control , reduced the rate of progression of diabetic retinopathy . ( Funded by the National Heart , Lung , and Blood Institute and others ; Clinical Trials.gov numbers , NCT00000620 for the ACCORD study and NCT00542178 for the ACCORD Eye study .
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 .