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Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38
Open accessAbstract
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 β 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.
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In the citing paper
“Hypertension is not only more prevalent in persons with T2D than in the general population, but hypertension also predicts progression to T2D.”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [182]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Antihypertensive therapy reduces the risk of albuminuria (67)(68)(69)(70), and among people with type 1 or 2 diabetes with established CKD (eGFR <60 mL/min/1.73m 2 and UACR $300 mg/g creatinine), ACE inhibitor or ARB therapy reduces the risk of progression to ESKD (71)(72)(73)(74)(75)(76)(77)(78)(79)(80).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [69]
The cited source says what the claim attributes to it.
In the citing paper
“Antihypertensive therapy reduces the risk of albuminuria (68-71), and among people with type 1 or 2 diabetes with established CKD (eGFR <60 mL/min/1.73m 2 and UACR ≥300 mg/g creatinine), ACE inhibitor or ARB therapy reduces the risk of progression to kidney failure (72)(73)(74)(75)(76)(77)(78)(79)(80)(81).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [70]
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In the citing paper
“in the UK Prospective Diabetes Study (UKPDS) trial, intensive blood pressure management in people with type 2 diabetes reduced the risk for heart failure by 56% (276).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [276]
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In the citing paper
“For example, in the UK Prospective Diabetes Study (UKPDS) trial, intensive blood pressure management in people with type 2 diabetes reduced the risk for heart failure by 56% (273).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [273]
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In the citing paper
“However, trials of interventions for single risk factors have shown efficacy in reducing the development and progression of complications.[4][5][6][7][8][9]”
From Effect of a multifactorial intervention on mortality in type 2 diabetes (2008) · cites this paper as [5]
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In the citing paper
“Once diagnosed with hypertension, an individual is 2.5 times more likely to be diagnosed with T2D within the next 5 years.181,182”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [182]
Experimental — accuracy not yet measuredIn the citing paper
“Thiazolidinediones increased the risk of HF hospitalization in several trials and are not recommended in patients with diabetes and symptomatic HF. 165,[565][566][567]”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [566]
In the citing paper
“Pioglitazone is associated with an increased risk of incident HF in patients with diabetes and is not recommended for glucose-lowering treatment in patients at risk of HF (or with previous HF).165,566 III A”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [566]
In the citing paper
“There was a marked and significant 44% risk reduction for stroke and a non-significant 21% risk reduction for myocardial infarction associated with a 10 mmHg reduction in SBP and a 5 mmHg reduction in DBP.”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [441]
In the citing paper
“Randomized clinical trials have demonstrated the benefit (reduction of CHD events, stroke, and nephropathy) of lowering blood pressure to <140 mmHg systolic and <80 mmHg diastolic in individuals with diabetes (160,163–165).”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [163]
In the citing paper
“Though evidence for distinct advantages of RAS inhibitors on CVD outcomes in diabetes remains conflicting (163,182), the high CVD risks associated with diabetes, and the high prevalence of undiagnosed CVD, may still favor recommendations for their use as first-line hypertension therapy in people with diabetes (160).”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [163]
In the citing paper
“The UKPDS provided strong evidence that control of blood pressure can reduce the development of nephropathy (163).”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [163]
In the citing paper
“Lowering blood pressure has been shown to decrease the progression of retinopathy (163).”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [163]
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Metadata
- Authors
- UK Prospective Diabetes Study Group
- Corresponding author
- UK Prospective Diabetes Study Group,
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 1998-09-12
- Volume
- 317
- Issue
- 7160
- Pages
- 703-713
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- OpenAlex
- W3198570063
- Semantic Scholar
- 0689ea6f352bd212c4984871f32639f9e2ef70cb
- Cited by
- 6,683
- References
- 30
- Citations by year
- 2026: 61 · 2025: 99 · 2024: 96 · 2023: 129 · 2022: 145 · 2021: 120 · 2020: 140 · 2019: 168 · 2018: 208 · 2017: 204 · 2016: 230 · 2015: 212 · 2014: 263 · 2013: 277 · 2012: 268
- FWCI
- 173.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- 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
- tight blood pressure control, type 2 diabetes, hypertension, macrovascular complications, microvascular complications, diabetic retinopathy, diabetic nephropathy, urinary albumin excretion, stroke, captopril, atenolol, ACE inhibitors, beta-blockers, all-cause mortality, diabetes mortality, retinal photocoagulation
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