Document Detail

Hypertension in Diabetes Study IV. Therapeutic requirements to maintain tight blood pressure control.
MedLine Citation:
PMID:  8960842     Owner:  NLM     Status:  MEDLINE    
We report the efficacy of therapy over 5 years follow-up in 758 non-insulin-dependent diabetic patients in a prospective, randomised controlled study of therapy of mild hypertension. Patients were recruited who on antihypertensive therapy had systolic blood pressure over 150 mmHg or diastolic over 85 mmHg, or if not on therapy had systolic blood pressure over 160 mmHg or diastolic over 90 mmHg. Their mean blood pressure at entry to the study was 160/94 mmHg at a mean age of 57 years. They were allocated to tight control (aiming for systolic < 150/diastolic < 85 mmHg) or to less tight control (aiming for systolic < 180/diastolic < 105 mmHg). The tight control group were allocated to primary therapy either with a beta blocker (atenolol) or with an antiotensin converting enzyme inhibitor (captopril), with addition of other agents as required. Over 5 years, the mean blood pressure in the tight control group was significantly lower (143/82 vs 154/88 mmHg, p < 0.001). No difference was seen between those allocated to atenolol or captopril. The proportion of patients requiring three or more antihypertensive therapies to maintain tight control in those allocated to atenolol or captopril increased from 16 and 15%, respectively at 2 years to 25 and 26%, respectively at 5 years, whereas in the less tight control group at 2 and 5 years only 5 and 7%, respectively required three or more therapies. There was no difference in the incidence of side effects or hypoglycaemic episodes between those allocated to atenolol or captopril, but those allocated to atenolol increased their body weight by a mean of 2.3 kg compared with 0.5 kg in those allocated to captopril (p < 0.01). Allocation to atenolol was also associated with small increases in triglyceride, and decreases in LDL and HDL cholesterol, which are of uncertain clinical relevance. The study is continuing to determine whether the improved blood pressure control, which was obtained, will be beneficial in maintaining the health of patients by decreasing the incidence of major clinical complications, principally myocardial infarction and strokes, and microvascular complications, such as severe retinopathy requiring photocoagulation and deterioration of renal function.
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Diabetologia     Volume:  39     ISSN:  0012-186X     ISO Abbreviation:  Diabetologia     Publication Date:  1996 Dec 
Date Detail:
Created Date:  1997-03-28     Completed Date:  1997-03-28     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0006777     Medline TA:  Diabetologia     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  1554-61     Citation Subset:  IM    
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MeSH Terms
Adrenergic beta-Antagonists / adverse effects,  pharmacology,  therapeutic use
Angiotensin-Converting Enzyme Inhibitors / adverse effects,  pharmacology,  therapeutic use
Antihypertensive Agents / adverse effects,  pharmacology,  therapeutic use*
Atenolol / adverse effects,  pharmacology,  therapeutic use*
Blood Pressure / drug effects,  physiology*
Captopril / adverse effects,  pharmacology,  therapeutic use*
Cohort Studies
Diabetes Mellitus, Type 2 / blood,  complications*,  drug therapy,  physiopathology
Electrolytes / blood
Follow-Up Studies
Hypertension / blood,  drug therapy*,  physiopathology,  prevention & control
Hypoglycemia / epidemiology
Middle Aged
Prospective Studies
Time Factors
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 0/Electrolytes; 29122-68-7/Atenolol; 62571-86-2/Captopril
Erratum In:
Diabetologia 1997 Mar;40(3):366

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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