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Long-term benefit with blood pressure control, but not tight glucose control, in established type 2 diabetics
Prior studies of type 1 diabetics and newly diagnosed type 2 diabetics have suggested long-term reduction in mortality and macrovascular event risk resulting from earlier periods of tight glucose control. In the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial, blood pressure control in patients with type 2 diabetes resulted in lower risk of death, macrovascular, and microvascular events. However, this study did not find similar benefit from tight glycemic control. The present study extends the observation of patients in this trial to 6-years after completion of the trial to assess for a long-term benefit associated with a period of tight glycemic control. Of the 10261 patients eligible for continuation, 8494 consented to continued observation. Between-group differences in blood pressure and glycemic control observed during the trial period were no longer evident by the first post-trial visit (median of 3.5 years after completion of the trial). Over a median follow-up of nearly 6 years (for a total of nearly 10 years including time in trial), patients in the blood pressure treatment group demonstrated a significant reduction in their risk of death or death from cardiovascular causes (HR=0.91, 95% CI, 0.84 to 0.99; P=0.03). Similar benefit was not observed for patients previously randomized …