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 metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in-Congestive Heart Failure (MERIT-HF)
BACKGROUND Metoprolol can improve haemodynamics in chronic heart failure , but survival benefit has not been proven . We investigated whether metoprolol controlled release/extended release ( CR/XL ) once daily , in addition to st and ard therapy , would lower mortality in patients with decreased ejection fraction and symptoms of heart failure . METHODS We enrolled 3991 patients with chronic heart failure in New York Heart Association ( NYHA ) functional class II-IV and with ejection fraction of 0.40 or less , stabilised with optimum st and ard therapy , in a double-blind r and omised controlled study . R and omisation was preceded by a 2-week single-blind placebo run-in period . 1990 patients were r and omly assigned  metoprolol CR/XL 12.5 mg ( NYHA III-IV ) or 25.0 mg once daily ( NYHA II ) and 2001 were assigned  placebo .  The target dose was 200 mg once daily and doses were up-titrated over 8 weeks . Our primary endpoint was all-cause mortality , analysed by intention to treat . FINDINGS The study was stopped early on the recommendation of the independent safety committee . Mean follow-up time was 1 year . All-cause mortality was lower in the metoprolol CR/XL group than in the placebo group ( 145 [ 7.2 % , per patient-year of follow-up ] ) vs 217 deaths [ 11.0 % ] , relative risk 0.66 [ 95 % CI 0.53 - 0.81 ] ; p=0.00009 or adjusted for interim analyses p=0.0062 ) . There were fewer sudden deaths in the metoprolol CR/XL group than in the placebo group ( 79 vs 132 , 0.59 [ 0.45 - 0.78 ] ; p=0.0002 ) and deaths from worsening heart failure ( 30 vs 58 , 0.51 [ 0.33 - 0.79 ] ; p=0.0023 ) . INTERPRETATION Metoprolol CR/XL once daily in addition to optimum st and ard therapy improved survival . The drug was well tolerated
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 .