Newly diagnosed hypertensive patients with type 2 diabetes (n = 1544) Randomisation Avoid ACE inhibitors/ beta-blockers (n = 390) Tight BP control (n = 758) Less tight BP control (n = 390) ACE inhibitor to maximum dose (n = 400) Beta-blocker to maximum dose (n = 358) Previous antihypertensive treatment BP ≥ 150/85 mm Hg (n = 421) No previous antihypertensive treatment BP ≥ 160/90 mm Hg (n = 727) UKPDS 38: BMJ 1998;317:703–13 UKPDS 38: study design

UKPDS 38: participant characteristics Tight (n = 758) Less tight (n = 390) Age (years) BMI (kg/m 2 ) HbA 1c Systolic BP (mm Hg) Diastolic BP (mm Hg)94 On antihypertensive treatment (%) Total cholesterol (mmol/l) HDL cholesterol (mmol/l)1.1 Current Smokers (%) UKPDS 38: BMJ 1998;317:703–13

UKPDS 38: tight control had a greater effect on blood pressure Blood pressure (mm Hg) Baseline9 years Tight Less tight Systolic BP Baseline9 years Diastolic BP UKPDS 38: BMJ 1998;317:703–13

UKPDS 38: relative risk reduction with tight blood pressure control Relative risk reduction tight vs less tight BP control (%) Microvascular endpoint Diabetes death MI All-cause mortality Stroke Peripheral vascular disease Any diabetes endpoint ** * p < 0.05 ** p < 0.01 ** * * UKPDS 38: BMJ 1998;317:703–13

UKPDS 39: similar effects of beta-blocker and ACE inhibitor Any diabetes endpoint Blood pressure (mm Hg) Years from randomisation Captopril Atenolol Systolic Diastolic Microvascular Diabetes death MI Stroke PVD Absolute risk (events/1000 patients years) Captopril Atenolol Adapted from: BMJ 1998;317:713–20

UKPDS 39: reasons for non-compliance non-compliant patients (%) Captopril Atenolol Cough Increased creatinine Intermittent claudication Bronchospasm Impotence GI Dizzy, tired, unwell Depression Headache Allergic reaction UKPDS 39: BMJ 1998;317:713–20