Author(s): Adler AI, Stratton IM, Neil HA, Yudkin JS, Matthews DR, et al.
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.
Referred From: https://www.ncbi.nlm.nih.gov/pubmed/10938049
Author(s): Selby JV, Ray GT, Zhang D, Colby CJ
Author(s): Sidorov J, Shull R, Tomcavage J, Girolami S, Lawton N, et al.
Author(s): Cutajar J
Author(s): Costa J, Borges M, David C, Vaz Carneiro A
Author(s): IDF Clinical Guidelines Task Force
Author(s): Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, et al.
Author(s): Selby JV, Karter AJ, Ackerson LM, Ferrara A, Liu J
Author(s): The Mount Hood 4 Modeling Group
Author(s): Clark CM Jr, Snyder JW, Meek RL, Stutz LM, Parkin CG
Author(s): Marcantonio ER, Goldman L, Mangione CM, Ludwig LE, Muraca B, et al.
Author(s): Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, et al.
Author(s): Carr MC, Brunzell JD
Author(s): van Leiden HA, Dekker JM, Moll AC, Nijpels G, Heine RJ, et al.
Author(s): Stevens RJ, Kothari V, Adler AI, Stratton IM; United Kingdom Prospective Diabetes Study (UKPDS) Group
Author(s): Serrano Rios M
Author(s): Adler AI, Boyko EJ, Ahroni JH, Stensel V, Forsberg RC, et al.
Author(s): Retnakaran R, Cull CA, Thorne KI, Adler AI, Holman RR
Author(s): Bakris GL, Williams M, Dworkin L, Elliott WJ, Epstein M, et al.
Author(s): Ravid M, Brosh D, Ravid-Safran D, Levy Z, Rachmani R
Author(s): Park JY, Kim HK, Chung YE, Kim SW, Hong SK, et al.
Author(s): Tuomilehto J, Rastenyte D, Birkenhäger WH, Thijs L, Antikainen R, et al.
Author(s): Hansson L, Zanchetti A, Carruthers SG, Dahlöf B, Elmfeldt D, et al.
Author(s): Curb JD, Pressel SL, Cutler JA, Savage PJ, Applegate WB, et al.
Author(s): Anderson JW, Kendall CW, Jenkins DJ
Author(s): Metascreen Writing Committee, Bonadonna R, Cucinotta D, Fedele D, Riccardi G, et al.
Author(s): Costa LA, Canani LH, Lisbôa HR, Tres GS, Gross GL
Author(s): Handelsman Y, Jellinger PS
Author(s): Bonora E, Targher G, Formentini G, Calcaterra F, Lombardi S, et al.
