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Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study

Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study
Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study

Objective: to determine the relation between systolic blood pressure over time and the risk of macrovascular or microvascular complications in patients with type 2 diabetes.

Design: prospective observational study.

Setting: 23 hospital based clinics in England, Scotland, and Northern Ireland.

Participants: 4801 white, Asian Indian, and Afro-Caribbean UKPDS patients, whether randomised or not to treatment, were included in analyses of incidence; of these, 3642 were included in analyses of relative risk.

Outcome measures: primary predefined aggregate clinical outcomes: any complications or deaths related to diabetes and all cause mortality. Secondary aggregate outcomes: myocardial infarction, stroke, lower extremity amputation (including death from peripheral vascular disease), and microvascular disease (predominantly retinal photocoagulation). Single end points: non-fatal heart failure and cataract extraction. Risk reduction associated with a 10 mm Hg decrease in updated mean systolic blood pressure adjusted for specific confounders

Results: the incidence of clinical complications was significantly associated with systolic blood pressure, except for cataract extraction. Each 10 mm Hg decrease in updated mean systolic blood pressure was associated with reductions in risk of 12% for any complication related to diabetes (95% confidence interval 10% to 14%, P<0.0001), 15% for deaths related to diabetes (12% to 18%, P<0.0001), 11% for myocardial infarction (7% to 14%, P<0.0001), and 13% for microvascular complications (10% to 16%, P<0.0001). No threshold of risk was observed for any end point.

Conclusions: in patients with type 2 diabetes the risk of diabetic complications was strongly associated with raised blood pressure. Any reduction in blood pressure is likely to reduce the risk of complications, with the lowest risk being in those with systolic blood pressure less than 120 mm Hg.

0959-8146
412-419
Adler, Amanda I.
d02dfdd6-ca6f-4cdc-91ab-8eb79ff94d7f
Stratton, Irene M.
772f25b9-23c0-4240-a3f6-1e76b03b172f
Neil, H. Andrew W.
ded0352b-edc2-499f-a8b9-51f82489f985
Yudkin, John S.
a0b1ae7c-c872-4143-82a7-8007bd6bdb41
Matthews, David R.
7a492d3d-2803-42b1-8c41-6719e3171bcf
Cull, Carole A.
ae95233f-ce25-4c32-a5b9-368419e07826
Wright, Alex D.
2e61eeb7-e4ec-4556-912e-eb86315d49cf
Turner, Robert C.
f974acc5-a17a-49c4-8bb7-84fa4d449863
Holman, Rury R.
336fb2f7-edb5-4d65-a7b0-465111cbd047
on behalf of the UK Prospective Diabetes Study Group
Adler, Amanda I.
d02dfdd6-ca6f-4cdc-91ab-8eb79ff94d7f
Stratton, Irene M.
772f25b9-23c0-4240-a3f6-1e76b03b172f
Neil, H. Andrew W.
ded0352b-edc2-499f-a8b9-51f82489f985
Yudkin, John S.
a0b1ae7c-c872-4143-82a7-8007bd6bdb41
Matthews, David R.
7a492d3d-2803-42b1-8c41-6719e3171bcf
Cull, Carole A.
ae95233f-ce25-4c32-a5b9-368419e07826
Wright, Alex D.
2e61eeb7-e4ec-4556-912e-eb86315d49cf
Turner, Robert C.
f974acc5-a17a-49c4-8bb7-84fa4d449863
Holman, Rury R.
336fb2f7-edb5-4d65-a7b0-465111cbd047

Adler, Amanda I., Stratton, Irene M., Neil, H. Andrew W., Yudkin, John S., Matthews, David R., Cull, Carole A., Wright, Alex D., Turner, Robert C. and Holman, Rury R. , on behalf of the UK Prospective Diabetes Study Group (2000) Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. British medical journal, 321 (7258), 412-419. (doi:10.1136/bmj.321.7258.412).

Record type: Article

Abstract

Objective: to determine the relation between systolic blood pressure over time and the risk of macrovascular or microvascular complications in patients with type 2 diabetes.

Design: prospective observational study.

Setting: 23 hospital based clinics in England, Scotland, and Northern Ireland.

Participants: 4801 white, Asian Indian, and Afro-Caribbean UKPDS patients, whether randomised or not to treatment, were included in analyses of incidence; of these, 3642 were included in analyses of relative risk.

Outcome measures: primary predefined aggregate clinical outcomes: any complications or deaths related to diabetes and all cause mortality. Secondary aggregate outcomes: myocardial infarction, stroke, lower extremity amputation (including death from peripheral vascular disease), and microvascular disease (predominantly retinal photocoagulation). Single end points: non-fatal heart failure and cataract extraction. Risk reduction associated with a 10 mm Hg decrease in updated mean systolic blood pressure adjusted for specific confounders

Results: the incidence of clinical complications was significantly associated with systolic blood pressure, except for cataract extraction. Each 10 mm Hg decrease in updated mean systolic blood pressure was associated with reductions in risk of 12% for any complication related to diabetes (95% confidence interval 10% to 14%, P<0.0001), 15% for deaths related to diabetes (12% to 18%, P<0.0001), 11% for myocardial infarction (7% to 14%, P<0.0001), and 13% for microvascular complications (10% to 16%, P<0.0001). No threshold of risk was observed for any end point.

Conclusions: in patients with type 2 diabetes the risk of diabetic complications was strongly associated with raised blood pressure. Any reduction in blood pressure is likely to reduce the risk of complications, with the lowest risk being in those with systolic blood pressure less than 120 mm Hg.

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More information

Published date: 12 August 2000
Additional Information: A correction has been attached to this output located at https://www.bmj.com/content/322/7278/90.1

Identifiers

Local EPrints ID: 487036
URI: http://eprints.soton.ac.uk/id/eprint/487036
ISSN: 0959-8146
PURE UUID: df868525-79c9-4d1c-b28c-e50c3f216a0e
ORCID for Irene M. Stratton: ORCID iD orcid.org/0000-0003-1172-7865

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Date deposited: 09 Feb 2024 17:49
Last modified: 06 Jun 2024 02:10

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Contributors

Author: Amanda I. Adler
Author: Irene M. Stratton ORCID iD
Author: H. Andrew W. Neil
Author: John S. Yudkin
Author: David R. Matthews
Author: Carole A. Cull
Author: Alex D. Wright
Author: Robert C. Turner
Author: Rury R. Holman
Corporate Author: on behalf of the UK Prospective Diabetes Study Group

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