Effects of Different Blood Pressure–Lowering Regimens on Major Cardiovascular Events in Individuals With and Without Diabetes Mellitus
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- 27 June 2005
- journal article
- research article
- Published by American Medical Association (AMA) in Archives of Internal Medicine
- Vol. 165 (12), 1410-1419
- https://doi.org/10.1001/archinte.165.12.1410
Abstract
Background Blood pressure (BP) level is a major determinant of cardiovascular morbidity and mortality in individuals with diabetes mellitus. Several guidelines recommend lower BP goals and specific drug classes for these patients. The overviews reported herein were performed to formally compare the effects on cardiovascular events and death of different BP-lowering regimens in individuals with and without diabetes. Methods Twenty-seven randomized trials (N = 158 709 participants) that included 33 395 individuals with diabetes and 125 314 without diabetes contributed to these analyses. For each outcome and each comparison summary, estimates of effect and 95% confidence intervals were calculated for patients with and without diabetes using a random-effects model. The constancy of the effects of each treatment regimen in participants with and without diabetes was examined using χ2 tests of homogeneity. Results Total major cardiovascular events were reduced to a comparable extent in individuals with and without diabetes by regimens based on angiotensin-converting enzyme inhibitors, calcium antagonists, angiotensin receptor blockers, and diuretics/β-blockers (P > .19 for all by χ2 test of homogeneity). There was limited evidence that lower BP goals produced larger reductions in total major cardiovascular events in individuals with vs without diabetes (P = .03 by χ2 test of homogeneity). Conclusions These overviews showed that the short- to-medium-term effects on major cardiovascular events of the BP-lowering regimens studied were broadly comparable for patients with and without diabetes. Different effects of regimens on intermediate renal outcomes not evaluated in these overviews may still provide a rationale for using specific drug classes in patients with diabetes.Keywords
This publication has 23 references indexed in Scilit:
- Global Prevalence of DiabetesDiabetes Care, 2004
- Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004—BHS IVJournal of Human Hypertension, 2004
- The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood PressureThe JNC 7 ReportJAMA, 2003
- Diabetes-Related Morbidity and Mortality in a National Sample of U.S. EldersDiabetes Care, 2002
- Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenololThe Lancet, 2002
- Renoprotective Effect of the Angiotensin-Receptor Antagonist Irbesartan in Patients with Nephropathy Due to Type 2 DiabetesThe New England Journal of Medicine, 2001
- Effects of Losartan on Renal and Cardiovascular Outcomes in Patients with Type 2 Diabetes and NephropathyThe New England Journal of Medicine, 2001
- The Quinapril Ischemic Event Trial (QUIET): evaluation of chronic ace inhibitor therapy in patients with ischemic heart disease and preserved left ventricular functionThe American Journal of Cardiology, 2001
- Effect of Amlodipine on the Progression of Atherosclerosis and the Occurrence of Clinical EventsCirculation, 2000
- Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trialThe Lancet, 1998