Screening Adults for Type 2 Diabetes: A Review of the Evidence

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Table 3. Studies Comparing One Antihypertensive Drug with Another

Study (Quality)	Study Age (y)	N Groups	Blood Pressure Control	MI	Stroke	CVD Events Mortality	Non-CVD Outcomes	Adherence Withdrawal	Blinding (Comments)
UKPDS-39, 1998 (63) (Diabetics) (fair)	8.4 56	Captopril: 400	144/83	20.2¹	6.8¹	DM related death 15.2¹ 12.0 (p=0.28)	No difference vision, ESRD	D/C study drug 22% 35%	Open label; blinded outcome assessment
UKPDS-39, 1998 (63) (Diabetics) (fair)	8.4 56	Atenolol: 358	143/81	16.9 (p=0.35)	6.1 (p=0.74)	DM related death 15.2¹ 12.0 (p=0.28)	No difference vision, ESRD	D/C study drug 22% 35%	Open label; blinded outcome assessment
CAPPP, 1999 (76); 2001 (68) (Diabetes subgroup) (fair)	6.1 55-56	Captopril: 309	155.5/89	3.9%	7.4%	All cause 6.5% 12.9% (p=0.034)	NR	One patient lost to followup; compliance with medications not reported	Open label; blinded outcome assessment
CAPPP, 1999 (76); 2001 (68) (Diabetes subgroup) (fair)	6.1 55-56	Conventional: 263	153.5/88	10.3% (p=0.002)	7.2% (p=0.96)	All cause 6.5% 12.9% (p=0.034)	NR		Open label; blinded outcome assessment
STOP-2, 2000 (66) (Diabetes subgroup) (fair)	5.3 75-76	ACEI: 235	161.3/80.3	15.3¹	31.6¹	All cause 49.0¹ 43.9 55.5 (p=0.20)	NR	Taking drug at end ACEI : 61.3% CA: 66.2% D/beta: 62.3% 0% withdrew	Open label; blinded outcome assessment
		CA: 231	161.8/79.1	29.6	26.9
		Conventional: 253 (D/beta)	161.3/81.2	22.2 (p=0.025)	34.7 (p=0.36)
ABCD, 1998 (64) (hypertensive) (Diabetics) (fair)	5 57	Nisoldipine: 235	135/82	10.6%	4.7%	CVD death 4.3% 2.1% (NS)	No difference vision, ESRD	D/C study drug: 39.1% 34.9%	Double-blind; MI a secondary endpoint; blinded outcome assessment
ABCD, 1998 (64) (hypertensive) (Diabetics) (fair)	5 57	Enalapril: 235	135/82	2.1% (p=0.001)	3.0% (NS)	CVD death 4.3% 2.1% (NS)	No difference vision, ESRD	D/C study drug: 39.1% 34.9%
FACET, 1998 (67) (Diabetics) (fair)	2.5 62-63	Fosinopril: 189	157/88	1.8²	0.7²	Major CVD event 2.6² 5.0 (p=0.03)	NR	D/C study drug 19.0% 27.2% 1% withdrew	Open label; blinded outcome assessment
FACET, 1998 (67) (Diabetics) (fair)	2.5 62-63	Amlodipine: 191	153/86	2.4² (p>0.1)	1.9 (p>0.1)	Major CVD event 2.6² 5.0 (p=0.03)	NR	D/C study drug 19.0% 27.2% 1% withdrew	Open label; blinded outcome assessment
NORDIL, 2000 (70) (Diabetes subgroup) (fair)	4.5 60-61	Diltiazem: 351	152.2/87.6	11.2¹	13.3¹	CVD events 29.8¹ 27.7 (p=0.98)	NR	Taking drug at end 77% 93% <1% withdrew	Open label; blinded outcome assessment
NORDIL, 2000 (70) (Diabetes subgroup) (fair)	4.5 60-61	D/beta: 376	149.1/87.4	11.1 (p=0.99)	12.3 (p=0.97)	CVD events 29.8¹ 27.7 (p=0.98)	NR	Taking drug at end 77% 93% <1% withdrew	Open label; blinded outcome assessment
INSIGHT, 2000 (69) (Diabetes subgroup) (fair)	4 65	Nifedipine: 649 (GITS)	138/82	NR	NR	CVD events 8.3% 8.4% (NS)	NR	D/C study drug 33.1% 39.9% 2.4% withdrew	Double-blind; blinded outcome assessment (Randomization imbalance in diabetic subgroup)
INSIGHT, 2000 (69) (Diabetes subgroup) (fair)	4 65	Co-amilozide: 653 (diuretic)	138/82	NR	NR	CVD events 8.3% 8.4% (NS)	NR	D/C study drug 33.1% 39.9% 2.4% withdrew
LEWIS et al., 2001 (71) (Diabetics) (good)	2.6 58-59	Irbesartan: 579	140/77	NR	NR	CV outcome³ 23.8% 22.6% 25.3% (NS)	Renal outcome⁴ 32.6% (p=0.006) 41.1% 39.0% (p=0.02)	<1% withdrew	Double-blind; blinded outcome assessment (Randomized by central office)
		Amlodipine: 567	141/77
		Placebo: 569	144/80
ABCD, 2002 (62) (normotensive) (Diabetics) (fair)	5.3 58-59	Nisoldipine: 234	132.1/78.0	7.7%	4.7%	All cause mortality 8.1% 7.7% (p=0.87)	No differences in renal and visual outcomes	Participants taking study drug ~70% of time	Double-blind; placebo controlled; blinded outcome assessment
ABCD, 2002 (62) (normotensive) (Diabetics) (fair)	5.3 58-59	Enalapril: 246	132.4/78.0	6.5% (p=0.61)	2.4% (p=0.18)	All cause mortality 8.1% 7.7% (p=0.87)	No differences in renal and visual outcomes	Participants taking study drug ~70% of time
LIFE, 2002 (75); LIFE 2002 (74) (Diabetes subgroup) (good)	4.7 67	Losartan: 586	146/79	7%	9%	All cause mortality 11% 17% (p=0.002)	NR	Taking drug at end 73% 68%	Double-blind; blinded outcome assessment
LIFE, 2002 (75); LIFE 2002 (74) (Diabetes subgroup) (good)	4.7 67	Atenolol: 609	148/79	8% (p=0.37)	11% (p=0.20)	All cause mortality 11% 17% (p=0.002)	NR	Taking drug at end 73% 68%	Double-blind; blinded outcome assessment

¹ Events per 1,000 person - years.
² Events per 100 person - years.
³ MI, stroke, cardiovascular death, amputation, congestive heart failure.
⁴ Doubling of creatinine, end-stage renal disease, any death.

Notes: ESRD = end stage renal disease, DM = diabetes mellitus, UKPDS = UK Prospective Diabetes Study Group, CAPPP = Captopril Prevention Project, STOP-2 = Swedish Trial in Old Patients with Hypertension-2, ABCD = Appropriate Blood Pressure Control in Diabetes, FACET = Fosinopril Versus Amlodipine Cardiovascular Events Randomized Trial, NORDIL = Nordic Diltiazem study, INSIGHT = Intervention as a Goal in Hypertension Treatment, NR = not reported, ACEI = angiotensin converting enzyme inhibitor, CA = calcium antagonist, D/beta = diuretics and/or beta blockers, NS = not statistically significant, D/C = discontinue, CVD = cardiovascular disease, GITS = gastrointestinal-transport-system, LIFE = Losartan Intervention For Endpoint reduction in hypertension study.

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