UKHDS UKPDS: UK Hypertension in Diabetes Study

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UKHDS (UKPDS) UK Hypertension in Diabetes
Study

• Purpose
• To determine whether tight control of blood
  pressure (aiming for BP lt150/85 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 199831770313.

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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 lt150/85 mmHg, or less tight control aiming for
  BP lt180/105 mmHg. Other agents added if control
  criteria not met (frusemide, nifedipine,
  methyldopa and prazosin)

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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, P0.13)

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UKHDS (UKPDS) UK Hypertension in Diabetes
Study- RESULTS BP Control and side effects -

Mean systolic and diastolic BP
160
Blood pressure
(mmHg)
140
100
Less tight control
(n156)
80
Tight control
(n297)
0
3
2
1
4
5
6
7
8
9
Years from randomization
UK Prospective Diabetes Study Group. BMJ
199831770313.
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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

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UKHDS (UKPDS) UK Hypertension in Diabetes
Study- RESULTS Morbidity and mortality -

Clinical events per 1000 patient years
Tight control
Less tight
Relative risk for tight
P
Clinical end point
(n758)
control (n390)
control (95 CI)
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UKHDS (UKPDS) UK Hypertension in Diabetes
Study- RESULTS Morbidity and mortality -

Progression of retinopathy and deterioration in
vision
Tight control
Less tight
Relative risk for tight
P
()
control ()
control (95 Cl)
Progression of retinopathy
by gt 2 steps
20.2
23.1
0.88 (0.60

1.29)
0.38
Median 1.5 years
27.5
36.7
0.75 (0.55

1.02)
0.019
Median 4.5 years
34.0
51.3
0.66 (0.50

0.89)
0.0038
Median 7.5 years
Deterioration in vision
by gt
3 ETDRS lines
a
Median 1.5 years
5.4
6.8
0.79 (0.39

1.62)
0.39
Median 4.5 years
7.5
8.9
0.83 (0.44

1.59)
0.47
Median 7.5 years
10.2
19.4
0.53 (0.30

0.93)
0.0036
a
ETDRS early treatment of diabetic retinopathy
study
UK Prospective Diabetes Study Group. BMJ
199831770313.
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UKHDS (UKPDS) UK Hypertension in Diabetes Study
- SUMMARY -

• In hypertensive patients with type 2 diabetes,
  long-term tight BP control aiming to keep BP
  lt150/85 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 acuity