UKHDS (UKPDS): UK Hypertension in Diabetes Study
Purpose
To determine whether tight control of blood pressure (aiming for BP <150/85 mmHg) reduces/prevents complications and reduces mortality in hypertensive patients with type 2 diabetes
Reference
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998;317:703–13.
UKHDS (UKPDS): UK Hypertension in Diabetes Study - TRIAL DESIGN -
Design
Randomized, open, controlled trial
Patients
1148 hypertensive patients with type 2 diabetes, mean age 56 years, mean BP at entry 160/94 mmHg
Follow up and primary endpoint
Mean follow up 8.4 years. Primary endpoints morbidity and mortality related to diabetes and all-cause mortality
Treatment
Tight control of BP with ACE inhibitor (captopril) or beta-blocker (atenolol) aiming for BP <150/85 mmHg, or less tight control aiming for BP <180/105 mmHg. Other agents added if control criteria not met (frusemide, nifedipine, methyldopa and prazosin)
UKHDS (UKPDS): UK Hypertension in Diabetes Study - RESULTS: BP Control and side effects -
Mean BP during follow up maintained at significantly lower level in group assigned to tight control (144/82 mmHg) than in group assigned to less tight control (154/87 mmHg)
29% of patients in group assigned to tight control required three or more antihypertensive treatments to maintain BP at target levels
No significant difference in cumulative incidence of hypoglycemia in groups assigned to tight (6.1%) and less tight (4.4%) BP control
Mean weight gain similar in both groups (1.3 and 2.0 kg, respectively, P=0.13)
UKHDS (UKPDS): UK Hypertension in Diabetes Study - RESULTS: BP Control and side effects -
Mean systolic and diastolic BP
Years from randomization
0
80
3
2
1
4
5
6
7
8
9
100
140
160
Blood pressure
(mmHg)
Less tight control
(n=156)
Tight control
(n=297)
UK Prospective Diabetes Study Group. BMJ 1998;317:703–13.
UKHDS (UKPDS): UK Hypertension in Diabetes Study - RESULTS: Morbidity and mortality -
Group assigned tight BP control had significant reduction in:
All diabetes-related endpoints combined
Death related to diabetes
Stroke (fatal or non-fatal)
Microvascular end points combined (predominantly due to significantly reduced risk of retinal photocoagulation)
Heart failure
Less deterioration of retinopathy and visual acuity in group assigned tight BP control
Trends towards reduction in MI, PVD, amputation, fatal/non-fatal renal failure and all-cause mortality were not significant
UKHDS (UKPDS): UK Hypertension in Diabetes Study - RESULTS: : Morbidity and mortality -
Tight control
(n=758)
P
Clinical events per 1000 patient years
Less tight
control (n=390)
Relative risk for tight
control (95% CI)
Clinical end point
UKHDS (UKPDS): UK Hypertension in Diabetes Study - RESULTS: : Morbidity and mortality -
Tight control
(%)
P
Progression of retinopathy and deterioration in vision
UK Prospective Diabetes Study Group. BMJ 1998;317:703–13.
Less tight
control (%)
Relative risk for tight
control (95% Cl)
Progression of retinopathy
by > 2 steps
Median 1.5 years
Median 4.5 years
Median 7.5 years
Deterioration in vision
by >
3 ETDRS lines
a
Median 1.5 years
Median 4.5 years
Median 7.5 years
20.2
27.5
34.0
5.4
7.5
10.2
23.1
36.7
51.3
6.8
8.9
19.4
0.88 (0.60
–
1.29)
0.75 (0.55
–
1.02)
0.66 (0.50
–
0.89)
0.79 (0.39
–
1.62)
0.83 (0.44
–
1.59)
0.53 (0.30
–
0.93)
0.38
0.019
0.0038
0.39
0.47
0.0036
a
ETDRS = early treatment of diabetic retinopathy study
UKHDS (UKPDS): UK Hypertension in Diabetes Study - SUMMARY -
In hypertensive patients with type 2 diabetes, long-term tight BP control aiming to keep BP <150/85 mmHg by use of an ACE inhibitor or beta-blocker (plus additional anti-hypertensive treatment if necessary):
Achieved mean BP of 144/82 mmHg
Reduced risk of diabetic complications and death related to diabetes
Reduced risk of progression of diabetic retinopathy and deterioration in visual acuit