Combination therapy is best

Combining BP control with intensive glucose lowering can reduce the risk of cardiovascular disease and renal complications in patients with type-2 diabetes, Australian research shows.

The ADVANCE trial randomised 11,140 patients across 20 countries to placebo or BP lowering using a fixed dosage of the ACE inhibitor perindopril and the diuretic indapamide. Patients in each group were then randomised to receive either standard blood glucose lowering or intensive treatment with gliclazide plus other drugs.

According to researchers, combination therapy reduced the risk of death from cardiovascular disease by 24 per cent, risk of nephropathy by 33 per cent and all-cause mortality by 20 per cent. Analysis showed the effects of the two treatments are independent and additive for all clinical outcomes.

N Engl J Med 2008; 358: 2,560-72.

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