What’s new about this?
This is the first time it’s been proven that reducing blood pressure in patients with type 2 diabetes, regardless of their hypertensive status, reduces risk of death and cardiovascular events, using Preterax (Coversyl Plus in the UK).
How significant is this study?
It’s the first and largest of its kind:
- Landmark five year study called ADVANCE, published online in The Lancet on 2nd September
- 11,140 patients with type 2 diabetes from 20 countries worldwide, including the UK
How is this relevant for UK clinicians?
According to the doctors we have spoken to, the study is so relevant for clinical practice that every GP, specialist and nurse with an interest in diabetes and CVD should be aware of the implications of the results. CVD is the major cause of death in people with type 2 diabetes, accounting for between 50% and 80% of all diabetes fatalities.
What are the implications of this study for clinical practice?
There is genuine excitement around the findings of the study as it demonstrates that it is beneficial to achieve targets for blood pressure in type 2 diabetic patients that are in line with the British Hypertension Society therapeutic guidelines. These targets are even lower that the audit targets set by the QOF.
Which doctors are available for comment?
- Dr George Kassianos - GP
- Dr John Pittard - GP
- Dr Mark Davis - GP
- UK lead investigator Neil Poulter - Consultant in General Medicine
- Professor Antony Barnett – Consultant in Diabetes
Major ADVANCE in Diabetes Research
Contact RDC to set up interviews with any of the above
Blood pressure lowering drug shown to save lives in type 2 diabetes
European Society of Cardiology (ESC) meeting, VIENNA: Routine administration of a blood pressure lowering drug to patients with diabetes - a fixed combination of perindopril (ACE inhibitor) and indapamide (diuretic), known as Preterax (Coversyl Plus in the UK†), significantly reduces risk of death and cardiovascular events, irrespective of initial blood pressure status or other diabetes related treatments.1 This is according to results of the blood pressure–lowering arm of the landmark five year study, ADVANCE** headlining at the ESC today and published online in The Lancet.1
The relative risk reduction of cardiovascular-related death was reduced by 18%* (3.8% active vs 4.6% placebo) and death from any cause was reduced by 14%* (7.3% active vs 8.5% placebo).1 In absolute terms, one death could be avoided for about 80 patients treated with Preterax over five years.1 In addition to this, the relative risk reduction of renal events was reduced by 21%.1
Dr George Kassianos, GP and Fellow of the European Society of Cardiology commented, “This study is genuinely exciting because it provides a rationale for considering such treatment routinely for patients with type 2 diabetes. It can save lives and reduce cardiovascular complications, regardless of whether patients have hypertension to start with or not – which has never been proven before. For doctors, this demonstrates that the therapeutic targets for blood pressure should actually be in line with levels suggested in the British Hypertension Society Guidelines and supported by the Joint British Societies Guidelines.”
In the UK, there are 1.8 million people known to have diabetes.2 Diabetes UK estimates that by the end of this decade the number could increase to three million people.2 Cardiovascular disease (CVD) is the major complication of type 2 diabetes.3 Overall, CVD ranks as the major cause of death in diabetes, accounting for between 50% and 80% of all diabetes fatalities.3
ADVANCE is the first and largest trial ever performed with a fixed combination antihypertensive in type 2 diabetic patients. The multicentre, randomised, placebo controlled study involved a total of 11,140 patients with type 2 diabetes from 20 countries worldwide, including the UK. Patients included were both normotensive and hypertensive and were already receiving most of the usual treatments provided to patients with diabetes, including other blood pressure lowering drugs.
The ADVANCE study was initiated and designed by the investigators and co-sponsored by The George Institute for International Health and the University of Sydney, and Servier. A second arm of the study, that sets out to assess the risks and benefits of intensive glucose lowering using a gliclazide MR-based regimen (Diamicron MR) will report later.
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Notes to editors:
Perindopril / indapamide combinations are registered under the following trade names: Preterax, BiPreterax, Preterax Forte, Biprel, Noliprel, Noliprel Forte, Prelectal, Prelectal forte, Predonium, Noriplel, Coversyl Plus, Coversyl Comp, Coversum Combi, Armix Comb, Prestarium Combi, Prestarium Plus.
Preterax and Diamicron MR are registered products of Servier.
† About Preterax® and Coversyl® Plus
Preterax® and Coversyl Plus® consist of the same active ingredients, perindopril and indapamide, in different doses.
Preterax is a first-line combination of perindopril and indapamide (2.0 mg perindopril / 0.625 mg indapamide). It is used in the ADVANCE study but is not available for use in the UK.
Coversyl Plus is licensed in the UK to control essential hypertension where blood pressure is not adequately controlled on perindopril alone. It is a combination of perindopril and indapamide (4.0 mg perindopril / 1.25 mg indapamide)
1 Data presented at a hotline session of the European Society of Cardiology meeting 2 September 2007
2 Diabetes UK, http://www.diabetes.org.uk/ (Accessed August 2007)
3 International Diabetes Federation (IDF). Diabetes and Cardiovascular Disease.
http://www.eatlas.idf.org/Complications/Diabetes_and_cardiovascular_disease/ (Accessed August 2007)