Cited by 6,683Blood Pressure and Hypertension StudiesDiabetes Treatment and ManagementDiabetes, Cardiovascular Risks, and Lipoproteins

The DOI matches its Crossref record; 30 of the 30 references it cites were found in a registry or an index.

Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38

Open access
UK Prospective Diabetes Study Group,·1998·BMJ

Abstract

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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Research works printed but not linked: 14

  1. 10.1097/00004872-199303000-00013 · DOI
  2. 10.1007/BF02374494 · DOI
  3. 1992, MRC trial oft reatment of hypertension in older adults: principal results., BMJ, 304, 405, 10.1136/bmj.304.6824.405 · DOI
  4. Sanderson, 1996, Hypertension in the elderly: pressure tot reat?, Health Trends, 28, 117
  5. 1994, HDS 3: Prospective study of therapy in type 2 diabetic patients efficacy of ACE inhibitor and -blocker., Diabet Med, 11, 773, 10.1111/j.1464-5491.1994.tb00352.x · DOI
  6. 1998, UKp rospective diabetes study 33: intensive blood glucose control withs ulphonylureas or insulin compared with conventional treatment and risk ofc omplications in patients with type 2 diabetes, Lancet, 352, 837, 10.1016/S0140-6736(98)07019-6 · DOI · Paper page
  7. 1982, Dietary recommendationsf or diabetics for the 1980s., Hum Nutr Appl Nutr, 36, 378
  8. 10.1001/jama.1991.03460240051027 · DOI · Paper page
  9. 1994, UK Prospective Diabetes Study XI: biochemical risk factors in type 2 diabetic patients at diagnosis compared witn age-matched normals ubjects., Diabet Med, 11, 534, 10.1111/j.1464-5491.1994.tb02032.x · DOI
  10. Manley, 1992, Decreases in albumin/creatinine and N-acetylglucosaminidase/creatinine ratiosi n urine samples stored at -20°C., Clin Chem, 38, 2294, 10.1093/clinchem/38.11.2294 · DOI
  11. Klein, 1989, The Wisconsin Epidemiologic Study of Diabetic Retinopathy. XI. The incidence ofm acular edema., Ophthalmology, 96, 1501, 10.1016/S0161-6420(89)32699-6 · DOI
  12. 1992, Clinical practiceg uidelines., Can Med Assoc J, 147, 697
  13. Bauduceau, 1996, Hypertension arterielle et diabète. Membres desc onseils d'administration et scientifiques de l'ALFEDIAM., Diabetes Metab, 22, 64
  14. 10.1001/archinte.1997.00440420033005 · DOI · Paper page

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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
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
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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