{"doi":"10.1136/bmj.317.7160.703","title":"Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38","abstract":"<jats:title>Abstract</jats:title>\n                  <jats:p>\n                    <jats:bold>Objective:</jats:bold>\n                    To determine whether tight control of blood pressure prevents macrovascular and microvascular complications in patients with type 2 diabetes.\n                  </jats:p>\n                  <jats:p>\n                    <jats:bold>Design:</jats:bold>\n                    Randomised controlled trial comparing tight control of blood pressure aiming at a blood pressure of &lt;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 &lt;180/105 mm Hg.\n                  </jats:p>\n                  <jats:p>\n                    <jats:bold>Setting:</jats:bold>\n                    20 hospital based clinics in England, Scotland, and Northern Ireland.\n                  </jats:p>\n                  <jats:p>\n                    <jats:bold>Subjects:</jats:bold>\n                    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.\n                  </jats:p>\n                  <jats:p>\n                    <jats:bold>Main outcome measures:</jats:bold>\n                    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.\n                  </jats:p>\n                  <jats:p>\n                    <jats:bold>Results:</jats:bold>\n                    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&lt;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.\n                  </jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion:</jats:bold>\n                    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.\n                  </jats:p>","journal":"BMJ","year":1998,"id":7107,"datarank":17.183859774148242,"base_score":8.811652248147043,"endowment":8.811652248147043,"self_citation_contribution":1.3217478372220566,"citation_network_contribution":15.862111936926187,"self_endowment_contribution":1.3217478372220566,"citer_contribution":15.862111936926187,"corpus_percentile":89.5,"corpus_rank":2029,"citation_count":6711,"citer_count":200,"citers_with_citation_signal":200,"citers_with_endowment":200,"datacite_reuse_total":0,"is_dataset":false,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"1998-09-12","authors":[{"id":64552,"name":"UK Prospective Diabetes Study Group","orcid":null,"position":0,"is_corresponding":false}],"reference_count":43,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-03-01T18:20:47.508186Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}