Blood pressure control, risk factors and cardiovascular prognosis in patients with diabetes: 30 years of progress.

Hypertension is a major co-morbidity for type 2 diabetes, and an important modifiable risk factor for vascular events. Therefore, treatment of diabetes and its risk factors is important to minimize complications, and much progress has been made over the past 30 years. The UKPDS trial showed that intensive glycaemic and blood pressure control reduced the risk of vascular events. In the HOT study, the addition of aspirin to patients with diabetes and controlled hypertension decreased the risk of myocardial infarction. Blood pressure control with angiotensin-converting enzyme inhibitors in MICRO-HOPE also showed significant reductions in the risk of vascular complications, and blockers of the renin-angiotensin system produced substantial renal protective effects in patients with hypertension and diabetes. Statin therapy in the HPS and CARDS studies was effective in the primary prevention of cardiovascular disorders. Finally, an intensive multifactorial intervention achieved sustained reduction in the risk of vascular complications and death in patients with type 2 diabetes in the Steno-2 study. Nevertheless, the major coronary event risk remains high in type 2 diabetes patients, and the results of the ADVANCE trial provided a step forward in treatment.