News:Diabetes Care Makes an "ADVANCE" with Better Blood Pressure Control

September 3, 2007 By Sabina A. Murphy, M.P.H. [mailto:smurphy@perfuse.org]

The ADVANCE trial enrolled high-risk, type 2 diabetic patients with or without a history of hypertension in a randomized, double-blind fashion. Patients received either a fixed combination of perindopril and indapamide once daily (n=5569) or matching placebo (n=5571).

At the end of the 4 year follow-up, blood pressure was lowered from 145 / 81 mmHg at baseline to 134.7 / 74.8 mmHg in the perindopril/indapamide group, a mean of 5.6 / 2.2 mmHg lower than the placebo group (p < 0.001).

The perindopril/indapamide combination reduced death by 14% over placebo, with much of the decrease coming from lower cardiovascular death, which was reduced by 18%. The primary endpoint, a composite of a variety of vascular events including cardiovascular death, stroke, MI, and new or worsening nephropathy or retinopathy, also declined with the perindopril/indapamide combination therapy (15.5% vs. 16.8%, RRR 9%, p = 0.041).

The UK Prospective Diabetes Study previously showed that reducing blood pressure confers a reduction in vascular events in hypertensive diabetic patients, but in that study the mean blood pressure at the end of follow was 145 mmHg, or 10 mmHg higher than in ADVANCE. The upcoming ACCORD trial addresses the issue of whether even lower blood pressure in diabetes will result in even fewer clinical events.

Global projections of the number of diabetics worldwide approaches 250 million for the year 2007. Professor Stephen MacMahon, presenter of the ADVANCE trial data at the ESC, noted that "If the benefits observed in ADVANCE were applied to just half the world’s diabetic population, then approximately 1.5 million deaths could be avoided over a 5-year period from 2010 to 2015."

Sources

ADVANCE Collaborative Group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): Lancet 2007; DOI:10.1016/S0140-6736(07)61303-8. http://www.thelancet.com.