Long-Term Follow-up after Tight Control of Blood Pressure in Type 2 Diabetes

Further information: Endocrine Disorders of the Heart (see p2295) from Cardiovascular Medicine, 3rd Edn*
 
Patients originally studied in the United Kingdom Prospective Diabetes Study (UKPDS) were investigated for post-trial monitoring to determine whether risk reductions for microvascular and macrovascular disease, achieved with the use of improved blood-pressure control during the trial, were sustained [1]. The original trial was performed from 1987–1991, and 5102 patients with newly diagnosed type 2 diabetes mellitus who enrolled in the UKPDS trial were randomly assigned to tight blood-pressure control regimen involving an angiotensin-converting-enzyme (ACE) inhibitor or a beta-blocker, or a less-tight blood pressure control regimen that excluded these mediators.

In the group receiving tight control, there were relative risk reductions of 24% for any diabetes-related end point, 32% for diabetes-related death, 44% for stroke, and 37% for microvascular disease. After a 5-year follow-up, reports from data obtained from patients suggested that there may be a continuing effect of earlier improved management of risk factors. When the trial ended in 1991, patients entered a 10-year post-trial monitoring program, and information was obtained by clinic visits and questionnaires; by years 6–10, funding constraints resulted in the use of questionnaires only. The current paper reports the results of a 10-year, post-interventional follow-up of the survivor cohort of the UKPDS blood-pressure study using data obtained from the documentation of hospitals and general practitioners. The authors examined whether a continued benefit of earlier improved blood-pressure control was evident, and if there were continued benefit, the degree to which it continued.

The report concluded that the benefits of previously improved blood-presssure control were not sustained when blood pressure differences were no longer maintained. Optimal blood pressure control is of major importance in patients with type 2 diabetes and reduces the risks of microvascular and macrovascular disease, if blood-pressure control is maintained.

[1] Holman RR, Paul SK, Bethel A, et al. Long-term follow-up after tight control of blood pressure in type 2 diabetes. N Engl J Med 2008;359:1565-76

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