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November 17, 2011

posted Nov 14, 2011, 7:39 AM by Bonni Stahl   [ updated Nov 21, 2011, 9:05 AM by David de Gijsel ]
YuanPu Zheng  

In a throw back to the days before strict BP guideline, Yuan looked at the UKPDS 38. The study began in 1987 and continued for 9 years. In this study of relatively newly diagnosed diabetics, with incredible glucose control entering the study (baseline hgb A1C's below 7), patients were randomized to tight BP control < 150/ 85 vs lenant BP control < 180/105. Of note the lenant BP control arm was intially SBP<200 when the study was intially designed. The primary outcomes was first clinical end point related to DM, Death related to DM, Death from all causes. The outcome commitee was blinded to patients' study arm. At study end the mean BP was 144/82 in the tight control group with 29% of tight control patients on 3 or more BP medications. In the lenant group the mean BP group was 154/87 with 11% in the lenant control group on 3 or more BP meds.  
This was in the days before statins, also the BP meds were confined to either captopril or atenolol vs nifedipine, lasix, methyldopa and prazosin limiting its generalizability in todays practice, but the outcomes are impressive with significant reductions in any DM related endpoint  RR 0.76, death related to DM RR 0.68, stroke RR 0.56, and microvascular disease RR 0.51. This give a NNT for 10 yrs of 6! for any DM related end point.
Our take home: This really illustrates the power of BP control. Although more recent studies warn us not to take this too far! ie the recent ACCORD BP trials. That failed to show a benefit in higher risk patient (that already have CAD) putting SBP goals of <120 vs <140.