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Research article:
Glucose, blood pressure and cholesterol levels and their relationships to clinical outcomes in type 2 diabetes: a retrospective cohort study
Reference:
Evangelos Kontopantelis, David A Springate, David Reeves, Darren M Ashcroft, Martin Rutter, Iain Buchan, Tim Doran(2015) Glucose, blood pressure and cholesterol levels and their relationships to clinical outcomes in type 2 diabetes: a retrospective cohort study. Diabetologia, doi: 10.1007/s00125-014-3473-8
- Link to fulltext article
- Abstract
- Background: Observational data have been used to inform target levels for modifiable risk factors in type 2 diabetes but these data are limited by confounding. We aimed to describe the shape of observed relationships between risk factor levels and clinically important outcomes in type 2 diabetes after adjusting for multiple confounders. Methods: We used retrospective longitudinal data on 246,544 adults with type 2 diabetes from 600 practices contributing to the Clinical Practice Research Datalink between 2006 and 2012. Proportional hazards regression models quantified the risks of mortality, microvascular or macrovascular events associated with four modifiable risk factors: glycated haemoglobin (HbA1c), systolic and diastolic blood pressure and total cholesterol, while controlling for numerous patient and practice covariates. Findings: U-shaped relationships were observed between all-cause mortality and levels of the four risk factors. The lowest risks were associated with HbA1c 7.25-7.75%; total cholesterol 3.5-4.5 mmol/L; systolic blood pressure 135-145 mmHg; and diastolic blood pressure 82.5-87.5 mmHg. coronary and stroke mortality related to the four risk factors in a positive, curvilinear way, with the exception of blood pressure which related to coronary deaths in a U-shape. Macrovascular events showed a positive and curvilinear relationship with HbA1c but U-shaped for total cholesterol and systolic blood pressure. Microvascular related to the four risk factors in a curvilinear way: positive for HbA1c and systolic blood pressure but negative for cholesterol and diastolic blood pressure. Interpretation: We identified several relationships which, when considered in the light of relevant trial data, support a call for major changes to clinical practice. Most importantly, our results support trial data indicating that normalisation of glucose and blood pressure can lead to poorer outcomes, which makes a strong case for target ranges for these risk factors rather than target levels.
- Author for correspondence
- Evangelos Kontopantelis
- Email for correspondence
- E.Kontopantelis@manchester.ac.uk
Code list: res9: alpha_blockers
92 codes in list
| Code | Coding system | Description | Entity type | List name | multilexcode | bnfcode | bnfchapter |
|---|---|---|---|---|---|---|---|
| 10088 | CPRD_product_code | DOXADURA tablets 4mg [DISCOVERY] | drug | res9: alpha_blockers | 10662001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 11394 | CPRD_product_code | BARATOL tablets 25mg [SHIRE] | drug | res9: alpha_blockers | 81001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 119 | CPRD_product_code | doxazosin tablets 1mg | drug | res9: alpha_blockers | 5457001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 12518 | CPRD_product_code | HYPOVASE BD starter pack [PFIZER] | drug | res9: alpha_blockers | 3195001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 1292 | CPRD_product_code | HYPOVASE tablets 1mg [PFIZER] | drug | res9: alpha_blockers | 453002 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 1294 | CPRD_product_code | doxazosin tablets 4mg | drug | res9: alpha_blockers | 5457003 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 13610 | CPRD_product_code | ALPHAVASE tablets 2mg [ASHBOURNE] | drug | res9: alpha_blockers | 920003 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 1455 | CPRD_product_code | prazosin tablets 500 micrograms | drug | res9: alpha_blockers | 4580001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 16198 | CPRD_product_code | BARATOL tablets 50mg [SHIRE] | drug | res9: alpha_blockers | 81002 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 16201 | CPRD_product_code | HYTRIN BPH tablets 2mg [AMDIPHARM] | drug | res9: alpha_blockers | 864002 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 19193 | CPRD_product_code | DOXAZOSIN tablets 2mg [TEVA] | drug | res9: alpha_blockers | 4009009 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 19216 | CPRD_product_code | DOXAZOSIN tablets 4mg [IVAX] | drug | res9: alpha_blockers | 4061009 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 19823 | CPRD_product_code | ALPHAVASE tablets 5mg [ASHBOURNE] | drug | res9: alpha_blockers | 904001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 20369 | CPRD_product_code | doxazosin oral suspension 1mg/5ml | drug | res9: alpha_blockers | 13651001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 2117 | CPRD_product_code | DORALESE TILTAB tablets 20mg [CHEMIDEX] | drug | res9: alpha_blockers | 5554001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 2345 | CPRD_product_code | HYTRIN BPH starter pack [AMDIPHARM] | drug | res9: alpha_blockers | 864001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 23459 | CPRD_product_code | HYPOVASE BENIGN PROSTATIC HYPERPLASIA tablets 2mg [PFIZER] | drug | res9: alpha_blockers | 5174001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 2346 | CPRD_product_code | HYTRIN tablets 5mg [ABBOTT] | drug | res9: alpha_blockers | 5110003 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 2347 | CPRD_product_code | HYTRIN tablets 10mg [ABBOTT] | drug | res9: alpha_blockers | 5111001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 2348 | CPRD_product_code | HYTRIN BPH tablets 10mg [AMDIPHARM] | drug | res9: alpha_blockers | 720001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 25047 | CPRD_product_code | HYPOVASE BENIGN PROSTATIC HYPERPLASIA tablets 500 micrograms [PFIZER] | drug | res9: alpha_blockers | 5173002 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 25487 | CPRD_product_code | CASCOR tablets 2mg [RANBAXY] | drug | res9: alpha_blockers | 9060001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 25551 | CPRD_product_code | CASCOR tablets 4mg [RANBAXY] | drug | res9: alpha_blockers | 9061001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 26237 | CPRD_product_code | ALPHAVASE tablets 500 micrograms [ASHBOURNE] | drug | res9: alpha_blockers | 920001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 26238 | CPRD_product_code | ALPHAVASE tablets 1mg [ASHBOURNE] | drug | res9: alpha_blockers | 920002 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 26693 | CPRD_product_code | HYPOVASE BENIGN PROSTATIC HYPERPLASIA BD starter pack [PFIZER] | drug | res9: alpha_blockers | 5173001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 2816 | CPRD_product_code | indoramin tablets 20mg | drug | res9: alpha_blockers | 5553001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 33094 | CPRD_product_code | DOXAZOSIN tablets 2mg [GEN (UK)] | drug | res9: alpha_blockers | 4000009 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 34342 | CPRD_product_code | DOXAZOSIN tablets 1mg [TEVA] | drug | res9: alpha_blockers | 4008009 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 34553 | CPRD_product_code | DOXAZOSIN tablets 4mg [GEN (UK)] | drug | res9: alpha_blockers | 4001009 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 34601 | CPRD_product_code | DOXAZOSIN tablets 1mg [GEN (UK)] | drug | res9: alpha_blockers | 3999009 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 34625 | CPRD_product_code | DOXAZOSIN tablets 2mg [HILLCROSS] | drug | res9: alpha_blockers | 4037009 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 3470 | CPRD_product_code | terazosin tablets 1mg | drug | res9: alpha_blockers | 5108001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 34715 | CPRD_product_code | DOXAZOSIN tablets 1mg [HILLCROSS] | drug | res9: alpha_blockers | 4036009 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 35272 | CPRD_product_code | DOXADURA XL tablets 4mg [GENUS] | drug | res9: alpha_blockers | 15167001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 35603 | CPRD_product_code | doxazosin oral suspension 4mg/5ml | drug | res9: alpha_blockers | 15465001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 36023 | CPRD_product_code | CARDOZIN XL tablets 4mg [HILLCROSS] | drug | res9: alpha_blockers | 14624001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 36649 | CPRD_product_code | HYTRIN tablets 2mg [AMDIPHARM] | drug | res9: alpha_blockers | 15534001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 36740 | CPRD_product_code | SLOCINX XL tablets 4mg [ZENTIVA] | drug | res9: alpha_blockers | 14953001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 36780 | CPRD_product_code | HYTRIN tablets 5mg [AMDIPHARM] | drug | res9: alpha_blockers | 15535001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 3715 | CPRD_product_code | prazosin tablets 5mg | drug | res9: alpha_blockers | 4581001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 37243 | CPRD_product_code | CARDOZIN XL tablets 4mg [TEVA] | drug | res9: alpha_blockers | 15451001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 37428 | CPRD_product_code | HYTRIN tablets 10mg [AMDIPHARM] | drug | res9: alpha_blockers | 15536001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 38461 | CPRD_product_code | CARDOZIN XL tablets 4mg [ARROW] | drug | res9: alpha_blockers | 15554001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 3923 | CPRD_product_code | terazosin bph starter pack 7 x 1mg + 14 x 2mg + 7 x 5mg | drug | res9: alpha_blockers | 10596001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 3924 | CPRD_product_code | terazosin tablets 5mg | drug | res9: alpha_blockers | 5108003 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 40256 | CPRD_product_code | BARATOL tablets 25mg [AMDIPHARM] | drug | res9: alpha_blockers | 16940001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 40678 | CPRD_product_code | DOXAZOSIN tablets 4mg [TEVA] | drug | res9: alpha_blockers | 4010009 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 40891 | CPRD_product_code | DOXAZOSIN tablets 2mg [IVAX] | drug | res9: alpha_blockers | 4059009 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 4111 | CPRD_product_code | HYPOVASE tablets 500 micrograms [PFIZER] | drug | res9: alpha_blockers | 453001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 41543 | CPRD_product_code | DOXAZOSIN tablets 1mg [IVAX] | drug | res9: alpha_blockers | 4057009 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 41651 | CPRD_product_code | PRAZOSIN tablets 500 micrograms [APS] | drug | res9: alpha_blockers | 1640009 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 41652 | CPRD_product_code | PRAZOSIN tablets 500 micrograms [HILLCROSS] | drug | res9: alpha_blockers | 1540009 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 41721 | CPRD_product_code | PRAZOSIN tablets 1mg [HILLCROSS] | drug | res9: alpha_blockers | 1540010 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 43547 | CPRD_product_code | PRAZOSIN tablets 500 micrograms [IVAX] | drug | res9: alpha_blockers | 1542010 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 43695 | CPRD_product_code | COLIXIL XL tablets 4mg [SANDOZ] | drug | res9: alpha_blockers | 15555001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 4449 | CPRD_product_code | CARDURA tablets 1mg [PFIZER] | drug | res9: alpha_blockers | 5458001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 445 | CPRD_product_code | prazosin titration pack 8x500micrograms + 32x1mg | drug | res9: alpha_blockers | 6855001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 45040 | CPRD_product_code | LARBEX XL prolonged release tablet 4mg [TEVA] | drug | res9: alpha_blockers | 18222001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 45265 | CPRD_product_code | DOXAZOSIN SR tablets 4mg [GEN (UK)] | drug | res9: alpha_blockers | 7300009 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 45328 | CPRD_product_code | DOXAZOSIN tablets 1mg [SANDOZ] | drug | res9: alpha_blockers | 4075009 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 45342 | CPRD_product_code | DOXAZOSIN tablets 4mg [SANDOZ] | drug | res9: alpha_blockers | 4077009 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 45583 | CPRD_product_code | DOXAZOSIN tablets 2mg [DEXCEL] | drug | res9: alpha_blockers | 4040009 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 46066 | CPRD_product_code | CARDOZIN XL tablets 4mg [ALMUS] | drug | res9: alpha_blockers | 18282001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 4637 | CPRD_product_code | terazosin tablets 2mg | drug | res9: alpha_blockers | 5108002 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 46526 | CPRD_product_code | RAPORSIN XL prolonged release tablet 4mg [ACTAVIS] | drug | res9: alpha_blockers | 18212001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 46922 | CPRD_product_code | PRAZOSIN tablets 1mg [IVAX] | drug | res9: alpha_blockers | 1542011 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 4694 | CPRD_product_code | terazosin starter pack 7 x 1mg + 21 x 2mg | drug | res9: alpha_blockers | 6464001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 47807 | CPRD_product_code | DOXAZOSIN XL tablets 4mg [HILLCROSS] | drug | res9: alpha_blockers | 7759009 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 4802 | CPRD_product_code | CARDURA tablets 2mg [PFIZER] | drug | res9: alpha_blockers | 5458002 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 48150 | CPRD_product_code | DOXAZOSIN tablets 1mg [ACTAVIS] | drug | res9: alpha_blockers | 4469009 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 4875 | CPRD_product_code | terazosin tablets 10mg | drug | res9: alpha_blockers | 5109001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 493 | CPRD_product_code | doxazosin tablets 2mg | drug | res9: alpha_blockers | 5457002 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 5183 | CPRD_product_code | HYPOVASE tablets 2mg [PFIZER] | drug | res9: alpha_blockers | 453003 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 5337 | CPRD_product_code | HYTRIN BPH tablets 5mg [AMDIPHARM] | drug | res9: alpha_blockers | 864003 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 5496 | CPRD_product_code | doxazosin modified release tablet 8mg | drug | res9: alpha_blockers | 11041002 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 5618 | CPRD_product_code | CARDURA XL modified release tablet 8mg [PFIZER] | drug | res9: alpha_blockers | 11518002 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 5815 | CPRD_product_code | indoramin tablets 25mg | drug | res9: alpha_blockers | 3874001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 582 | CPRD_product_code | doxazosin modified release tablet 4mg | drug | res9: alpha_blockers | 11041001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 591 | CPRD_product_code | prazosin tablets 1mg | drug | res9: alpha_blockers | 4580002 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 6008 | CPRD_product_code | OMNIC MR capsules 400micrograms [P & B] | drug | res9: alpha_blockers | 11014001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 7056 | CPRD_product_code | tamsulosin hydrochloride modified release tablet 400micrograms | drug | res9: alpha_blockers | 13260001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 726 | CPRD_product_code | prazosin tablets 2mg | drug | res9: alpha_blockers | 4580003 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 7547 | CPRD_product_code | DOXADURA tablets 2mg [DISCOVERY] | drug | res9: alpha_blockers | 10568001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 7549 | CPRD_product_code | DOXADURA tablets 1mg [DISCOVERY] | drug | res9: alpha_blockers | 2732001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 755 | CPRD_product_code | CARDURA XL modified release tablet 4mg [PFIZER] | drug | res9: alpha_blockers | 11518001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 8076 | CPRD_product_code | HYTRIN starter pack [AMDIPHARM] | drug | res9: alpha_blockers | 6463001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 8077 | CPRD_product_code | HYTRIN tablets 2mg [ABBOTT] | drug | res9: alpha_blockers | 5110002 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 8086 | CPRD_product_code | CARDURA tablets 4mg [PFIZER] | drug | res9: alpha_blockers | 5458003 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 8198 | CPRD_product_code | HYPOVASE tablets 5mg [PFIZER] | drug | res9: alpha_blockers | 454001 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 8863 | CPRD_product_code | HYPOVASE BENIGN PROSTATIC HYPERPLASIA tablets 1mg [PFIZER] | drug | res9: alpha_blockers | 5173003 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
| 9019 | CPRD_product_code | indoramin tablets 50mg | drug | res9: alpha_blockers | 3874002 | 02050400/07040101 | Alpha-blockers/Alpha-blockers (in urinary retention) |
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