Is the benefit of blood pressure control in type 2 diabetes mellitus sustained after 10 years?

Good control of blood pressure (defined as < 150/85 in this study) in patients with diabetes is critical, and this study reinforces the importance of maintaining good blood pressure control over time. (LOE = 2b)

Holman RR, Paul SK, Bethel MA, Neil HA, Matthews DR. Long-term follow-up after tight control of blood pressure in type 2 diabetes. N Engl J Med 2008;359(15):1565-1576.  [PMID:18784091]

Cohort (prospective)

Government

Outpatient (any)

This is a follow-up to the landmark United Kingdom Prospective Diabetes Study trial. Initially, 1148 patients with newly diagnosed type 2 diabetes mellitus and hypertension were randomized in a 2-to-1 ratio to tight blood pressure control with captopril or atenolol (target blood pressure of < 150/85 mm Hg) or less tight control without either drug (< 180/105 mm Hg). The mean age of patients was 56 years and 87% were white. The study found important reductions in any diabetes-related end point (including death), stroke, and microvascular disease among patients randomized to the tight control group over the 8-year mean follow-up period. At the end of the study, patients who had not died, emigrated, or dropped out (n = 884) were followed up for another 10 years. At the end of the 10-year period, 372 patients had completed post-trial monitoring. Over the 10-year period, differences in systolic and diastolic blood pressure between tight and loose blood control groups largely disappeared, as did benefits of tight control.