Long-term follow-up after tight control of blood pressure in type 2 diabetes
Open accessAbstract
BACKGROUND: Post-trial monitoring of patients in the United Kingdom Prospective Diabetes Study (UKPDS) examined whether risk reductions for microvascular and macrovascular disease, achieved with the use of improved blood-pressure control during the trial, would be sustained. METHODS: Among 5102 UKPDS patients with newly diagnosed type 2 diabetes mellitus, we randomly assigned, over a 4-year period beginning in 1987, 1148 patients with hypertension to tight or less-tight blood-pressure control regimens. The 884 patients who underwent post-trial monitoring were asked to attend annual UKPDS clinics for the first 5 years, but no attempt was made to maintain their previously assigned therapies. Annual questionnaires completed by patients and general practitioners were used to follow patients who were unable to attend the clinic in years 1 through 5, and questionnaires were used for all patients in years 6 to 10. Seven prespecified aggregate clinical end points were examined on an intention-to-treat basis, according to the previous randomization categories. RESULTS: Differences in blood pressure between the two groups during the trial disappeared within 2 years after termination of the trial. Significant relative risk reductions found during the trial for any diabetes-related end point, diabetes-related death, microvascular disease, and stroke in the group receiving tight, as compared with less tight, blood-pressure control were not sustained during the post-trial follow-up. No risk reductions were seen during or after the trial for myocardial infarction or death from any cause, but a risk reduction for peripheral vascular disease associated with tight blood-pressure control became significant (P=0.02). CONCLUSIONS: The benefits of previously improved blood-pressure control were not sustained when between-group differences in blood pressure were lost. Early improvement in blood-pressure control in patients with both type 2 diabetes and hypertension was associated with a reduced risk of complications, but it appears that good blood-pressure control must be continued if the benefits are to be maintained. (UKPDS 81; Current Controlled Trials number, ISRCTN75451837.)
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Post-trial monitoring of the UKPDS substudy showed no legacy effect, meaning intensive blood pressure control has to be maintained for continued benefit.
“Post-trial monitoring of the UKPDS substudy showed no legacy effect (i.e.intensive BP control has to be maintained for continued benefit).426”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [426]
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- Authors
- Holman, R. R., Paul, S. K., Bethel, M. A., Neil, H. A. W., & Matthews, D. R.
- Affiliations
- Churchill Hospital (GB)
- Oxford Centre for Diabetes, Endocrinology and Metabolism (GB)
- NIHR Oxford Biomedical Research Centre (GB)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2008-10-09
- Volume
- 359
- Issue
- 15
- Pages
- 1565-1576
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2141713511
- Cited by
- 762
- References
- 25
- Citations by year
- 2026: 9 · 2025: 13 · 2024: 19 · 2023: 23 · 2022: 16 · 2021: 24 · 2020: 28 · 2019: 40 · 2018: 34 · 2017: 45 · 2016: 39 · 2015: 50 · 2014: 44 · 2013: 53 · 2012: 64
- FWCI
- 62.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- GlaxoSmithKline
- Sanofi
- Wellcome Trust
- National Institute for Health and Care Research
- British Heart Foundation
- Diabetes UK
- University of Oxford
- Bayer HealthCare
- Novo Nordisk
- Servier
- National Institutes of Health
- Medical Research Council
- St. George's, University of London
- National Institute of Diabetes and Digestive and Kidney Diseases
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, hypertension, tight blood pressure control, microvascular complications, macrovascular complications, stroke, myocardial infarction, peripheral vascular disease, diabetes mortality, UKPDS
- MeSH terms
- Aged, Antihypertensive Agents, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Female, Follow-Up Studies, Humans, Hypertension, Male, Middle Aged, Surveys and Questionnaires, Risk, Kaplan-Meier Estimate
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