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 .
Outcomes With Nifedipine GITS or Co-Amilozide in Hypertensive Diabetics and Nondiabetics in Intervention as a Goal in Hypertension (INSIGHT)
Abstract —To investigate the impact of treatment on cardiovascular mortality and morbidity , we assessed outcomes in patients with hypertension and diabetes who received co-amilozide or nifedipine in the International Nifedipine GITS Study : Intervention as a Goal in Hypertension . Participants had to be 55 to 80 years of age , with hypertension ( ≥150/95 or ≥160 mm Hg ) and at least one additional cardiovascular risk factor . Patients received 30 mg nifedipine once daily or co-amilozide ( 25 mg hydrochlorothiazide and 2.5 mg amiloride ) daily . Doses were doubled if target blood pressures ( < 140/90 mm Hg ) were not achieved . Primary ( composite of cardiovascular death , myocardial infa rct ion , heart failure , and stroke ) and secondary outcomes ( composite of primary outcomes , including all-cause mortality and death from vascular and nonvascular causes ) were assessed by means of intent-to-treat analyses . There was no significant difference in the incidence of primary outcomes between nifedipine-treated and  co-amilozide – treated patients with diabetes at baseline ( n=1302 ) ( 8.3 % versus 8.4 % ; relative risk , 0.99 , 95 % CI , 0.69 to 1.42;P = 1.00 ) . A significant benefit for nifedipine-treated patients was seen for the composite secondary outcome ( 14.2 % versus 18.7 % ; relative risk , 0.76 , 95 % CI , 0.59 to 0.97;P = 0.03 ) . Among patients without diabetes at baseline ( n=5019 ) , there was a significant difference in the incidence of new diabetes ( nifedipine 4.3 % versus co-amilozide 5.6 % , P = 0.023 ) . Nifedipine GITS once daily is as effective as  diuretic therapy in reducing cardiovascular complications in hypertensive diabetics . Nifedipine-treated patients were also less likely to have diabetes or have secondary events ( a composite of all-cause mortality , death from a vascular cause , and death from a nonvascular cause ) than co-amilozide recipients . Our results suggest that nifedipine could be considered as first-line therapy for hypertensive diabetics
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 .