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Appropriate Blood Pressure Control in NIDDM (ABCD) Trial
R W Schrier1, R O Estacio, B Jeffers
1Department of Medicine, University of Colorado Health Sciences Center, Denver, USA.
Diabetologia
|December 1, 1996
Summary
Intensive blood pressure control in diabetes (NIDDM) significantly reduced diabetic complications. This trial compared intensive versus moderate control and evaluated specific antihypertensive drugs for preventing nephropathy and retinopathy.
Area of Science:
- Cardiology
- Nephrology
- Endocrinology
Background:
- Hypertension significantly impacts diabetic complications in non-insulin-dependent diabetes mellitus (NIDDM).
- Previous research indicates a strong link between elevated blood pressure and adverse outcomes in diabetic patients.
Purpose of the Study:
- To compare intensive versus moderate blood pressure control for preventing diabetic nephropathy, retinopathy, cardiovascular disease, and neuropathy in NIDDM patients.
- To assess the equivalency of calcium channel blockers (nisoldipine) and ACE inhibitors (enalapril) in managing these vascular complications.
Main Methods:
- A prospective, randomized clinical trial involving 950 NIDDM patients (hypertensive and normotensive).
- Patients were randomized to intensive or moderate antihypertensive therapy and assigned to either nisoldipine or enalapril.
- Primary outcome: glomerular filtration rate (24-h creatinine clearance); Secondary outcomes: urinary albumin excretion, left ventricular hypertrophy, retinopathy, neuropathy, and cardiovascular events.
Main Results:
- Intensive antihypertensive therapy demonstrated greater efficacy in preventing and slowing the progression of diabetic vascular complications compared to moderate control.
- Both nisoldipine and enalapril showed comparable effects as first-line agents in mitigating these complications.
- Analysis of secondary outcomes indicated significant benefits of intensive control on renal function and microvascular complications.
Conclusions:
- Intensive blood pressure management is crucial for reducing the burden of diabetic complications in NIDDM.
- First-line treatment with either ACE inhibitors or calcium channel blockers can be effective, with intensive control being the key factor for improved outcomes.