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The UKPDS also investigated the effects of
blood pressure control on the prevention of complications of diabetes. One
thousand one hundred forty-eight (1,148) of the randomized (4,297) patients
had hypertension (mean BP160/94 mm Hg). Patients were randomized to either an ACE inhibitor or a beta-blocker to achieve either tight BP control (<150/85 mm Hg) or less tight control (180/105 mm Hg), with avoidance of treatment with ACE inhibitors or beta-blockers. However, medications were permitted in each group if required to achieve or maintain goals. Mean BP was reduced significantly during the follow-up period (median 8.4 years) in the tight control group compared with the less tight control group, with mean BP of 144/82 mm Hg and 154/87 mm Hg, respectively. However, after 9 years of follow-up, three or more medications were required in the tight control group to sustain goal BP. Statistically significant reductions in both microvascular and macrovascular complications were observed in the tight control group vs the less tight control group. These reductions are illustrated on this slide. It should be noted that a reduction (not shown here) in all-cause mortality did not reach statistical significance. The investigators also found that the studied ACE inhibitor and beta-blocker were equally safe and effective. UK Prospective Diabetes Study Group. BMJ. 1998;317:703-713. UK Prospective Diabetes Study Group. BMJ. 1998;317:713-720. |