Blood pressure control and glucose lowering cuts cardiovascular disease risk

Analysis of results from the Action in Diabetes and Vascular Disease (ADVANCE) trial show that combining BP control with intensive glucose-lowering can reduce the risk of cardiovascular disease (CVD) and renal complications in patients with type-2 diabetes.

The ADVANCE trial randomised 11,140 patients across 20 countries to either 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 as required to reach an HbA1c of [less than or equal to] 6.5 per cent, in a 2x2 factorial design.

The mean age of patients was 65.8 years.

Results of the BP-lowering arm were published in 2007 and those of the blood glucose lowering arm in 2008.

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. In addition, analysis of the results shows the effects of the two treatments are independent and additive for all clinical outcomes.

Investigator Professor Bruce Neal, professor of medicine at The University of Sydney, said that these results ‘provide important confirmation that combination therapy is the way to go in diabetes’ and that ‘it is worth trying to stick to multiple therapies’.

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