Effects of blood pressure lowering on cardiovascular outcomes in different cardiovascular risk groups among participants with type 2 diabetes

• Published in: Diabetes research and clinical practice 2012-10, Vol.98 (1), p.83-90
• Main Authors: van Dieren, Susan, Kengne, Andre P, Chalmers, John, Beulens, Joline W.J, Cooper, Mark E, Grobbee, Diederick E, Harrap, Stephen, Mancia, Giuseppe, Neal, Bruce, Patel, Anushka, Poulter, Neil, van der Schouw, Yvonne T, Woodward, Mark, Zoungas, Sophia
• Format: Article
• Language: English
• Subjects: ADVANCE trial; Aged; Antihypertensive Agents - administration & dosage; Blood pressure; Blood Pressure - drug effects; Cardiovascular disease; Cardiovascular Diseases - physiopathology; Cardiovascular Diseases - prevention & control; Coronary heart disease; Diabetes mellitus; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - physiopathology; Diabetic Angiopathies - physiopathology; Diabetic Angiopathies - prevention & control; Drug Combinations; Endocrinology & Metabolism; Female; Framingham; Humans; Hypertension - complications; Hypertension - drug therapy; Indapamide - administration & dosage; Male; Mortality; Odds Ratio; Perindopril - administration & dosage; Risk Factors; Risk groups; Risk scores; Treatment Outcome; Type 2 diabetes
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2012.05.002

Abstract Aims To asses differences in treatment effects of a fixed combination of perindopril–indapamide on major clinical outcomes in patients with type 2 diabetes across subgroups of cardiovascular risk. Methods 11,140 participants with type 2 diabetes, from the ADVANCE trial, were randomized to perindopril–indapamide or matching placebo. The Framingham equation was used to calculate 5-year CVD risk and to divide participants into two risk groups, moderate–high risk (25% and/or history of macrovascular disease). Endpoints were macrovascular and microvascular events. Results The mean age of participants was 66 years (42.5% female). 1000 macrovascular and 916 microvascular events were recorded over follow-up of 4.3 years. Relative treatment effects were similar across risk groups, (all P -values for heterogeneity ≥0.38). Hazard ratios for combined macro- and microvascular events were 0.89 (0.77–1.03) for the moderate-high risk and 0.92 (0.81–1.03) for the very high risk. Absolute treatment effects tended to be greater in the high risk groups although differences were not statistically significant ( P > 0.05). Conclusions Relative effects of blood pressure lowering with perindopril–indapamide on cardiovascular outcomes were similar across risk groups whilst absolute effects trended to be greater in the high risk group.