Diabetic complications are associated with high blood pressure for type-2 diabetes patientsAssociation of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study.
- Njølstad, Inger MD, PhD
- Adler, AI
- Stratton, IM
- Neil, HAW
- Yudkin, JS
- Matthews, DR
- Cull, CA
- Wright, AD
- Turner, RC
- Holman, RR
BACKGROUND
Type-2 diabetes patients have above average rates of cardiovascular, cerebrovascular and renal disease which may be associated with higher blood pressure. Past research has measured blood pressure at one point in time, but tracking blood pressure changes provides more specific risk reduction information.
OBJECTIVE
To investigate the relationship between systolic blood pressure and micro- and macrovascular complications for people with type-2 diabetes.
SETTING
Twenty-three hospital clinics; England, Scotland, Northern Ireland.
METHOD
Prospective observational study.
LITERATURE REVIEW
No explicit strategy; 56 references cited.
PARTICIPANTS
4801 people aged 25-65 recruited into the UK Prospective Diabetes Study between 1977 and 1991 (of whom 3642 were included in relative risk analysis).
INTERVENTION
Blood pressure measurement at baseline and yearly intervals.
OUTCOMES
Diabetes-related complications or deaths; mortality; myocardial infarction; stroke; microvascular complications; lower leg amputation; risk reduction associated with 10 mm Hg decrease in average blood pressure; cataract extraction.
MAIN RESULTS
Apart from cataract extraction, clinical complications were associated with higher blood pressure even after controlling age, sex, ethnicity, smoking, glycaemia, lipid concentrations, and albuminuria. 10 mm Hg decreases in mean systolic blood pressure were associated with 15% risk reductions for diabetes-related deaths (95% CI 12% to 18%); 12% for diabetes complications (95% CI 10% to 14%); 13% for microvascular complications (95% CI 10% to 16%); and 11% for myocardial infarction (95% CI 7% to 14%).
AUTHORS' CONCLUSIONS
The risk of diabetic complications is associated with high blood pressure for patients with type-2 diabetes. Analysis shows the reduction in risk that can be achieved by lowering blood pressure. There is no threshold of systolic blood pressure for a substantive change in risk.