title: Combined intensive blood pressure and glycemic control does not produce an additive benefit on microvascular outcomes in type 2 diabetic patients.
abstract: A reduction of either blood pressure or glycemia decreases some microvascular complications of type 2 diabetes, and we studied here their combined effects. In total, 4733 older adults with established type 2 diabetes and hypertension were randomly assigned to intensive (systolic blood pressure less than 120 mm Hg) or standard (systolic blood pressure less than 140 mm Hg) blood pressure control, and separately to intensive (HbA1c less than 0.060) or standard (HbA1c 0.070-0.079) glycemic control. Prespecified microvascular outcomes were a composite of renal failure and retinopathy and nine single outcomes. Proportional hazard regression models were used without correction for type I error due to multiple tests. During a mean follow-up of 4.7 years, the primary outcome occurred in 11.4% of intensive and 10.9% of standard blood pressure patients (hazard ratio 1.08), and in 11.1% of intensive and 11.2% of standard glycemia control patients. Intensive blood pressure control only reduced the incidence of microalbuminuria (hazard ratio 0.84), and intensive glycemic control reduced the incidence of macroalbuminuria and a few other microvascular outcomes. There was no interaction between blood pressure and glycemic control, and neither treatment prevented renal failure. Thus, in older patients with established type 2 diabetes and hypertension, intensive blood pressure control improved only 1 of 10 prespecified microvascular outcomes. None of the outcomes were significantly reduced by simultaneous intensive treatment of glycemia and blood pressure, signifying the lack of an additional beneficial effect from combined treatment.
authors.affiliation: Case Western Reserve University, and Cleveland VA Medical Center, Cleveland, Ohio 44106-4951, USA. fxi2@case.edu
authors.forename: Faramarz
authors.initials: F
authors.lastname: Ismail-Beigi
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Craven
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: O'Connor
authors.forename: Diane
authors.initials: D
authors.lastname: Karl
authors.forename: Jorge
authors.initials: J
authors.lastname: Calles-Escandon
authors.forename: Irene
authors.initials: I
authors.lastname: Hramiak
authors.forename: Saul
authors.initials: S
authors.lastname: Genuth
authors.forename: William C
authors.initials: WC
authors.lastname: Cushman
authors.forename: Hertzel C
authors.initials: HC
authors.lastname: Gerstein
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Probstfield
authors.forename: Lois
authors.initials: L
authors.lastname: Katz
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schubart
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects*; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D004311:Double-Blind Method; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008833:Microcirculation / Q000187:drug effects*; D008875:Middle Aged; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D001786:Blood Glucose; D003404:Creatinine; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human