ADVANCE - how to optimize the prevention of diabetic complications. The results of pooled analysis of glucose-lowering and blood pressure arms of the ADVANCE study

Abstract

The recently published results of ADVANCE trial demonstrated the separate benefits of blood pressure lowering with the fixed combination of perindopril- -indapamide and of intensive glucose control with a gliclazide MR-based regimen on a range of outcomes including vascular complications of diabetes and mortality. The study was the biggest so far prospective trial on type 2 diabetes mellitus (n = 11,140). Separate analysis of both treatment arms of ADVANCE trial was recently followed by the assassement of magnitude and independence of both, hypoglycemic and hypotensive, effects. This article summarizes main results of combined analysis. The was no interaction between blood pressure lowering and intensive glucose control for any endpoints. Individuals randomized to Perindopril/Indapamide and Diaprel MR-based intensive blood glucose lowering, were characterized by reduction of risk of all-cause mortality by 18%, cardiovascular death by 24%, development or worsening of nephropathy by 33%. These results indicate that the separate effects of Perindopril/ Indapamide and intensive glucose control with Diaprel MR were independent for all outcomes, combined use of these treatments should be of substantial benefis for T2DM patients.