Believe it necessary

To study the effect of BP control on the complications of diabetes were included 1,148 patients with type 2 diabetes. Averages of blood pressure at baseline was 160/94 mmHg At randomization in 758 patients was necessary to attain BP <between 150/85 mm Hg (ォ strict control of blood pressure サ, the first group). Of these, 358 received the drug as the main bblokator atenolol (50 100 mg / d), 400 ACE inhibitor captopril (50 100 mg / day). The remaining 390 patients made up the second group it was necessary to maintain blood pressure below the level of <180/105 mmHg without the use of ACE inhibitors and bblokatorov. If necessary (when the target blood pressure levels were not achieved even with the appointment of maximal doses of atenolol and captopril) patients of the first group was administered additional drugs. In the group with less strict control of blood pressure, these additional drugs are prescribed as initial antihypertensive therapy. This is furosemide 20 mg / day (maximum 40 mg 2 times a day), prolonged nifedipine 10 mg 2 times per day (maximum 40 mg), methyldopa 250 mg twice a day (max. 500 mg) and prazosin 1 mg 3 times a day (max. 5 mg).

The primary endpoint of the study were any clinical outcomes related to diabetes (sudden death, death from hypo or hyperglycemia, myocardial infarction, angina, heart failure, stroke, kidney failure, amputation, bleeding in the lens, retinal detachment, blindness, or cataract extraction eyes ), and death related to diabetes (myocardial infarction, stroke, sudden death, heart disease, kidney disease, hypo or hyperglycemia), and death from all causes.

Secondary endpoints included myocardial infarction, stroke, amputation or death from peripheral vascular disease and microvascular complications (retinopathy requiring photocoagulation, bleeding in the lens or kidney failure).

In the UKPDS achieved outlined in the beginning of the study BP levels. After 9 years, mean BP was 144/82 mm Hg in the group of close monitoring of BP and 154/87 mm Hg in the group of less strict control of blood pressure. During these 9 years, approximately every third patient from the first group required the appointment of three or more antihypertensive drugs, compared with 11% of patients of another group. Only every third patient from group carefully monitor blood pressure were on monotherapy.

Analysis of the results of the study revealed that, compared with the second group in the group of close monitoring of blood pressure substantially and significantly decreased the risk of any clinical complications associated with diabetes, 24%; death associated with diabetes, 32%, stroke by 44% and microvascular complications 37% of retinal detachment by 34% reduction in visual acuity by 47%.

One of the most important results of this study is that careful monitoring of blood pressure in patients order brand viagra with diabetes and hypertension, at least as important as monitoring the level of glucose. Thus, the number of macrovascular complications increased by 15% with an increase in blood pressure by 10 mmHg compared with an increase of 11% with an increase in the level of glycated hemoglobin by 1%.

The results suggest that careful monitoring of blood pressure using bblokatorov or ACE inhibitors in patients with hypertension and type 2 diabetes significantly reduces the risk of death and complications associated with diabetes.

In the UKPDS study also found that tight control of blood pressure is beneficial economically. Although the cost of antihypertensive drugs for a group of strict control of blood pressure was two times higher than for the control group, it is completely leveled saving money spent on treatment of complications of diabetes.

Thus, considering the results of several large multicenter studies, current recommendations suggest that patients with diabetes treated hypertension should be a priority. In addition, researchers believe it necessary for these patients, the level of blood pressure is 130/85 mm Hg

An important finding of the study UKPDS was that b1selektivny blocker atenolol and the ACE inhibitor, captopril was equally effective as to achieve a hypotensive effect and to reduce the risk of diabetic complications. Thus, atenolol reduced BP to an average level of 143/81 mm Hg, and captopril to 144/83 mm Hg In this case, both drugs were equally effective in reducing the risk of fatal and nonfatal complications of diabetes, deaths related to diabetes, heart failure and progression of retinopathy.

In other words, there were no significant differences in the degree of reducing the risk of cardiovascular complications during therapy, based on an ACE inhibitor, or based on bblokatorah. Currently, ACE inhibitors are considered first-line drugs of choice for treating patients with diabetes and hypertension, as they are metabolically neutral and have a renoprotective effect. On the contrary, it was thought that bblokatory, taking into account some of their potentially adverse metabolic effects, are contraindicated in diabetes. The results of the UKPDS studies have put this point of view under great doubt.