Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38
Authors: M R Stearne, S L Palmer, M S Hammersley, S L Franklin, R S Spivey, J C Levy, C R Tidy, N J Bell, J Steemson, B A Barrow, R Coster, K Waring, J Nolan, E Truscott, N Walravens, L Cook, H Lampard, C Merle, P Parker, J McVittie, I Draisey, L E Murchison, A H E Brunt, M J Williams, D W Pearson, X M P Petrie, M E J Lean, D Walmsley, M J Lyall, E Christie, J Church, E Thomson, A Farrow, J M Stowers, M Stowers, K McHardy, N Patterson, A D Wright, N A Levi, A C I Shearer, R J W Thompson, G Taylor, S Rayton, M Bradbury, A Glover, A Smyth-Osbourne, C Parkes, J Graham, P England, S Gyde, C Eagle, B Chakrabarti, J Smith, J Sherwell, E M Kohner, A Dornhurst, M C Doddridge, M Dumskyj, S Walji, P Sharp, M Sleightholm, G Vanterpool, C Rose, G Frost, M Roseblade, S Elliott, S Forrester, M Foster, K Myers, R Chapman, J R Hayes, R W Henry, M S Featherston, G P R Archbold, M Copeland, R Harper, I Richardson, S Martin, H A Davison, D R Hadden, L Kennedy, A B Atkinson, A M Culbert, C Hegan, H Tennet, N Webb, I Robinson, J Holmes, P M Bell, D R McCance, J Rutherford, S Nesbitt, A S Spathis, S Hyer, M E Nanson, L M James, J M Tyrell, C Davis, P Strugnell, M Booth, H Petrie, D Clark, B Rice, S Hulland, J L Barron, J S Yudkin, B J Gould, J Singer, A Badenock, M Eckert, K Alibhai, E Marriot, C Cox, R Price, M Fernandez, A Ryle, S Clarke, G Wallace, E Mehmed, S MacFarlane, R H Greenwood, J Wilson, M J Denholm, R C Temple, K Whitfield, F Johnson, C Munroe, S Gorick, E Duckworth, M Flatman, S Rainbow, L J Borthwick, D J Wheatcroft, R J Seaman, R A Christie, W Wheatcroft, P Musk, J White, S McDougal, M Bond, P Raniga, R W Newton, R T Jung, C Roxburgh, B Kilgallon, L Dick, N Waugh, S Kilby, A Ellingford, J Burns, C Fox, M C Holloway, H M Coghill, N Hein, A Fox, W Cowan, M Richard, K Quested, S J Evans, R B Paisey, N P R Brown, A J Tucker, R Paisey, F Garrett, J Hogg, P Park, K Williams, P Harvey, R Wilcocks, S Mason, J Frost, C Warren, P Rocket, L Bower, J M Roland, D J Brown, J Youens, K Stanton-King, H Mungall, W Maddison, D Donnelly, S King, P Griffin, S Smith, S Church, G Dunn, A Wilson, K Palmer, P M Brown, D Humphriss, A J M Davidson, R Rose, L Armistead, S Townsend, P Poon, I D A Peacock, N J C Culverwell, M H Charlton, B P S Connolly, J Peacock, J Barrett, J Wain, W Beeston, G King, P G Hill, A J M Boulton, A M Robertson, Katoulis, A Olukoga, H McDonald, S Kumar, F Abouaesha, B Abuaisha, E A Knowles, S Higgins, J Booker, J Sunter, K Breislin, R Parker, P Raval, J Curwell, H Davenport, G Shawcross, A Prest, J Grey, H Cole, C Sereviratne, R J Young, T L Dornan, J R Clyne, M Gibson, I O'Connell, L M Wong, S J Wilson, K L Wright, C Wallace, D McDowell, A C Burden, E M Sellen, R Gregory, M Roshan, N Vaghela, M Burden, C Sherriff, J Clarke, J Grenfell, J E Tooke, K MacLeod, C Searnark, M Rammell, C Pym, J Stockman, C Yeo, J Piper, L Leighton, E Green, M Hoyle, K Jones, A Hudson, A J James, A Shore, A Higham, B Martin
Journal: BMJ (1998)

Objective: To determine whether tight control of blood pressure prevents macrovascular and microvascular complications in patients with type 2 diabetes. Design: Randomised controlled trial comparing tight control of blood pressure aiming at a blood pressure of <150/85 mm Hg (with the use of an angiotensin converting enzyme inhibitor captopril or a beta blocker atenolol as main treatment) with less tight control aiming at a blood pressure of <.180/105 mm Hg. Setting 20 hospital based clinics in England, Scotland, and Northern Ireland. Subjects: 1148 hypertensive patients with type 2 diabetes (mean age 56, mean blood pressure at entry 160/94 mm Hg); 758 patients were allocated to tight control of blood pressure and 390 patients to less tight control with a median follow up of 8.4 years. Main outcome measures: Predefined clinical end points, fatal and non-fatal, related to diabetes, deaths related to diabetes, and all cause mortality. Surrogate measures of microvascular disease included urinary albumin excretion and retinal photography. Results: Mean blood pressure during follow up was significantly reduced in the group assigned tight blood pressure control (144/82 mm Hg) compared with the group assigned to less tight control (154/87 mm Hg) (P< 0.0001). Reductions in risk in the group assigned to tight control compared with that assigned to less tight control were 24% in diabetes related end points (95% confidence interval 8% to 38%) (P= 0.0046), 32% in deaths related to diabetes (6% to 51%) (P= 0.019), 44% in strokes (11% to 65%) (P= 0.013), and 37% in microvascular end points (11% to 56%) (P= 0.0092), predominantly owing to a reduced risk of retinal photocoagulation. There was a non-significant reduction in all cause mortality. After nine years of follow up the group assigned to tight blood pressure control also had a 34% reduction in risk in the proportion of patients with deterioration of retinopathy by two steps (99% confidence interval 11% to 50%) (P= 0.0004) and a 47% reduced risk (7% to 70%) (P = 0.004) of deterioration in visual acuity by three lines of the early treatment of diabetic retinopathy study (ETDRS) chart. After nine years of follow up 29% of patients in the group assigned to tight control required three or more treatments to lower blood pressure to achieve target blood pressures. Conclusion: Tight blood pressure control in patients with hypertension and type 2 diabetes achieves a clinically important reduction in the risk of deaths related to diabetes, complications related to diabetes, progression of diabetic retinopathy, and deterioration in visual acuity.