Clinical Question: Does tight kin p...

Clinical Question: Does tight kin pressure control improve visual results in patients with diabetes and hypertension?

Setting: Outpatient (any)

consideration Design: Randomized controlled trial (double-blinded)

Allocation: Concealed

Synopsis: In this substudy of the landmark United Kingdom Prospective Diabetes cogitation 1,148 patients with hypertension and diabetes were assigned randomly in a 2:1 ratio to tight or set free control of blood pressure, with target life-current pressures of 150/85 mm Hg or 200/105 mm Hg respectively. The unloose control target pressure was changed to 185/105 mm Hg midway by the and of the study. Patients in the active treatment clump were further randomized to receive captopril or atenolol in standard dosages, increased until bridle was achieved, with furosemide, nifedipine, methyldopa, or prazosin added (in that order), if needed

The measure of retinopathy was evaluated at enrollment and each three years thereafter. Allocation to collections was concealed, outcome assessment was blinded, and analysis was on intention to treat. Patients were followed for a median of 93 years. The average relations pressure in the tight command group was 144/82 mm Hg and in the unfasten control group, it was 154/87 mm Hg The mean glycohemoglobins were similar in these groups: 72 percent during the first four years of the reflection and 8.2 to 8.3 percent for the final four years.

The tight check group had fewer micro-aneurysms after 45 years of follow-up (233 versus 335 percent in the liberate control group; number needed to treat [NNT] = 10) fewer hard exudates, fewer cotton wool taints less progression of retinopathy, and les ne for photocoagulation. These are all disease-oriented completion points and do not necessarily consequence in significant worsening of vision or visual loss

The primary patient-oriented results were blindness and reduction in visual acuity. Visual los in undivided eye was less likely in the tight curb group, occurring in 2.4 percent of patients compared with 31 percent in the liberate control group (P = 046) This corresponds to an absolute increase in risk with loosen control of approximately one for 1,000 patient-years of treatment. After nine years, a lower likelihood of deterioration in either view was noted in the tight mastery group (20.5 versus 32.8 percent; NNT = eight). However, there was no significant difference in the reduction of vision as assessed from the better eye.

An interesting finding, not otherwise explanationed on in the manuscript, was that 36 patients in the tight command group required cataract extraction compared with 14 patients in the relax control group. Judging by the other differences, this difference almost certainly was statistically significant.

Bottom Line: Tight children pressure control results in a small benefit in the prevention of blindness, with an NNT of 1000 patients for the same year. Tight control also is associated with a reduction in los of visual acuity after nine years (but not with shorter durations of follow-up) and an apparent increase in the likelihood of cataract extraction. (Level of Evidence: 1b)

consideration Reference: Matthews DR, et al. Risks of progression of retinopathy and vision los related to tight offspring pressure control in type 2 diabetes mellitus: UKPD 69 Arch Ophthalmol November 2004;122:1631-40

Used with permission from Ebell M Tight BP superintend prevents blindness in diabetics (UKPDS) Accessed online December 28 2004 at: http://www.InfoPOEMs.com.

COPYRIGHT 2005 American Academy of Family Physicians

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