Pour poursuivre la discussion sur l'HTA http://www.medscape.com/viewarticle/580370?src=mpnews <http://www.medscape.com/viewarticle/580370?src=mpnews&spon=2&uac=18687CK> &spon=2&uac=18687CK Intensive blood-pressure control: No "legacy effects"
In the blood-pressure arm of UKPDS, trial participants with hypertension were randomized to standard blood-pressure control or "tighter" control, permitting the addition of angiotensin-converting enzyme (ACE) inhibitors and beta blockers. In the 1997 results, patients in the more intensive blood pressure (BP)-control arm had experienced significant reductions in microvascular disease, but no significant benefits in terms of MI risk or all-cause mortality. Ten-year posttrial monitoring for the blood-pressure arm of the UKPDS was conducted in much the same way as the glucose portion of the trial, with clinic-based follow-up for the first five years, followed by questionnaire-based follow-up from 2002 to 2007. As Matthews told a packed conference room today, differences in blood-pressure levels seen in the original trial disappeared within two years postcompletion. As anticipated in 1997, 51% of the trial participants had died by the time the 10-year posttrial monitoring ended in 2007. But unlike the enduring benefits seen in survivors randomized to intensive glucose control, tighter control in the blood-pressure arm of the study produced no lasting improvements in microvascular disease, MI, all-cause mortality, or any diabetes-related end point. Indeed, differences in microvascular disease seen at the end of the trial had disappeared over the subsequent 10 years. Original and late-follow-up relative risk reduction with intensive BP lowering End point 1997: Relative risk reduction (%) 1997: p 2007: Relative risk reduction (%) 2007: p Any diabetes-related end point 24 0.0046 7 0.35 Microvascular disease 37 0.0092 16 0.20 MI 21 0.13 10 0.35 All-cause mortality 18 0.17 11 0.18 "Early improvement in blood-pressure control in patients with both type 2 diabetes and hypertension was associated with a reduced risk of complications, but it appears that good blood-pressure control must be continued if the benefits are to be maintained," the authors conclude. In a press statement, Matthews offered one hypothesis behind the disappointing blood-pressure results. '"With glucose control it matters how well you are treated now and how well you were treated in the past; with blood pressure, it seems to be related just to current therapy, confirming how essential it is to maintain good blood-pressure levels over time if the risk of complications is to be minimized." Holman, likewise, speculated that the findings speak to different pathophysiological mechanisms. "It does seem that the metabolism for glucose and its way of causing complications is very different from that of blood pressure," he told heartwire. "That's not really surprising blood pressure is a mechanical issue, but for glucose, with its effects on the endothelium, encouraging atherosclerosis, it's a longer-term process." Alain Vadeboncoeur Avis de confidentialité Ce courriel (de même que les fichiers qui y sont joints) peut contenir des renseignements protégés et confidentiels à l'intention du destinataire. Si vous en prenez connaissance sans justification, vous êtes, par cet avis, informé que toute diffusion ou reproduction de cette communication est interdite. Si vous avez reçu ce message par erreur, veuillez en aviser immédiatement l'expéditeur, détruire toutes les copies et le supprimer de votre système informatique. Merci.
