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Cited by 2,133Blood Pressure and Hypertension StudiesDiabetes, Cardiovascular Risks, and LipoproteinsCardiovascular Function and Risk Factors

Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study

Open access
Adler, A. I·2000·BMJ
DOI 10.1136/bmj.321.7258.412PMC PMC27455
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Abstract

OBJECTIVE: To determine the relation between systolic blood pressure over time and the risk of macrovascular or microvascular complications in patients with type 2 diabetes. DESIGN: Prospective observational study. SETTING: 23 hospital based clinics in England, Scotland, and Northern Ireland. PARTICIPANTS: 4801 white, Asian Indian, and Afro-Caribbean UKPDS patients, whether randomised or not to treatment, were included in analyses of incidence; of these, 3642 were included in analyses of relative risk. OUTCOME MEASURES: Primary predefined aggregate clinical outcomes: any complications or deaths related to diabetes and all cause mortality. Secondary aggregate outcomes: myocardial infarction, stroke, lower extremity amputation (including death from peripheral vascular disease), and microvascular disease (predominantly retinal photocoagulation). Single end points: non-fatal heart failure and cataract extraction. Risk reduction associated with a 10 mm Hg decrease in updated mean systolic blood pressure adjusted for specific confounders. RESULTS: The incidence of clinical complications was significantly associated with systolic blood pressure, except for cataract extraction. Each 10 mm Hg decrease in updated mean systolic blood pressure was associated with reductions in risk of 12% for any complication related to diabetes (95% confidence interval 10% to 14%, P<0.0001), 15% for deaths related to diabetes (12% to 18%, P<0.0001), 11% for myocardial infarction (7% to 14%, P<0.0001), and 13% for microvascular complications (10% to 16%, P<0.0001). No threshold of risk was observed for any end point. CONCLUSIONS: In patients with type 2 diabetes the risk of diabetic complications was strongly associated with raised blood pressure. Any reduction in blood pressure is likely to reduce the risk of complications, with the lowest risk being in those with systolic blood pressure less than 120 mm Hg.

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  • The combination of hypertension and T2D magnifies the risk of diabetes-related complications.

    “The combination of hypertension and T2D magnifies the risk of DM-related complications.183,184”

    From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [183]

  • The DCCT and UKPDS studies demonstrated a curvilinear relationship between attained A1C level and microvascular complications in type 1 and type 2 diabetes, respectively.

    “Additionally, the DCCT (43) and UKPDS (50) studies demonstrated a curvilinear relationship between attained A1C level and microvascular complications in type 1 and type 2 diabetes, respectively.”

    From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [50]

    The Results and Hazard ratios and risk reduction sections analyze systolic blood pressure and microvascular complications; HbA1c appears as an adjustment variable. A search for attained A1C, curvilinear risk, and glycaemia found no passage in this paper establishing the claimed A1C–microvascular relationship for type 2 diabetes. The References section lists UKPDS 35 on glycaemia, but that listing does not establish the specific claim. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

  • Findings from the DCCT and UKPDS studies demonstrate a curvilinear relationship between A1C and microvascular complications.

    “Findings from the DCCT (33) and UKPDS (49) studies demonstrate a curvilinear relationship between A1C and microvascular complications.”

    From 6. Glycemic Targets: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [49]

  • 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.

    “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 [165]

  • Observational analyses using data from the UKPDS have examined the relationship between exposure to glycaemia and levels of systolic BP over time, and the development of macrovascular and microvascular complications.

    “Observational analyses using data from the UKPDS have examined the relationship between exposure to glycaemia [8] and levels of systolic BP [9] over time, and the development of macrovascular and microvascular complications.”

    From A model to estimate the lifetime health outcomes of patients with Type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS no. 68) (2004) · cites this paper as [9]

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Research works printed but not linked: 3

  1. [3]3. Stratton IM, Adler AI, Neil HAW, Matthews DR, Manley SE, Cull CA, et al. Epidemiological association of glycaemia with macrovascular and micro- vascular complications of type 2 diabetes (UKPDS 35). BMJ 2000; 321:405-12.
  2. [8]8. Wei M, Gaskill SP, Haffner SM, Stern MP. Effects of diabetes and level of glycaemia on all-cause and cardiovascular mortality. Diabetes Care 1998;21:1167-72.
  3. [52]52. UKPDS Group. UK prospective diabetes study 16: overview of six years' therapy of type 2 diabetes-a progressive disease. Diabetes 1995;44:1249- 58.

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Authors
Adler, A. I.
Affiliations
University of Oxford (GB)
Corresponding author
Adler, A. I
ORCID
Adler, A. I
Venue
BMJ
Publisher
BMJ
Published
2000-08-12
Volume
321
Issue
7258
Pages
412-419
ISSN
0959-8138 (ISSN-L)
DOI
10.1136/bmj.321.7258.412
PMC
PMC27455
OpenAlex
W2172124430
Cited by
2,133
References
88
Citations by year
2026: 23 · 2025: 38 · 2024: 45 · 2023: 60 · 2022: 62 · 2021: 57 · 2020: 58 · 2019: 65 · 2018: 80 · 2017: 98 · 2016: 73 · 2015: 97 · 2014: 106 · 2013: 105 · 2012: 88
FWCI
65.01
Type
journal article
Language
en
Open access
Locations
  • BMJ (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • ePrints Soton (University of Southampton) (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • Bristol-Myers Squibb
  • Eli Lilly and Company
  • British Heart Foundation
  • Novo Nordisk
  • National Institutes of Health
  • Medical Research Council
  • National Eye Institute
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Keywords
systolic blood pressure, type 2 diabetes, macrovascular complications, microvascular complications, myocardial infarction, stroke, lower limb amputation, retinal photocoagulation, heart failure, cataract surgery, all-cause mortality, blood pressure reduction
MeSH terms
Adult, Aged, Cataract Extraction, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Female, Heart Failure, Humans, Hypertension, Male, Middle Aged, Myocardial Infarction, Prospective Studies, Regression Analysis, Risk, Systole, Incidence, Proportional Hazards Models, Stroke

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