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ADVANCE: Intensive glucose, BP-lowering therapy is safe, tolerated
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ROME — Combining intensive glucose control using gliclazide with intensive blood pressure-lowering using a fixed combination of perindopril and indapamide reduced the risk of cardiovascular events, mortality and kidney complications in patients with type 2 diabetes.
John Chalmers, MB, BS, BSc, PhD, presented results of the ADVANCE trial at the 44th Annual Meeting of the European Association for the Study of Diabetes.
Chalmers and colleagues conducted this randomized, factorial-designed trial in 215 centers in 20 different countries. They assessed the effects of serious vascular events and BP lowering in 11,140 patients with type 2 diabetes who were randomized to a fixed combination of perindopril (Aceon, Solvay Pharmaceuticals Inc.) and indapamide or matching placebo (n=5,571), and to standard or intensive glucose control using a gliclazide modified release-based regimen to achieve an HbA1c of 6.5% or less.
After 4.3 years of follow-up, results showed that treatment with the perindopril and indapamide combination reduced BP by 5.6 mm Hg/2.2 mm Hg compared with placebo, according to Chalmers. The relative risk for CVD mortality was reduced by 18% (P=.03), all-cause mortality was reduced by 14% (P=.03) and the risk for major macro- or microvascular events was reduced by 9% (P=.04).
“There were significant reductions of 14% in total coronary events and 21% in renal events,” said Chalmers, who is senior director and head of the research advisory unit at The George Institute for International Health, emeritus professor at The University of Sydney and emeritus professor at Flinders University Australia.
Findings also showed that patients in the intensive control group had a 10% reduced risk of major macro- or microvascular events (P=.01). The researchers did not find any significant effects of intensive glucose control on major macrovascular events, CV mortality or mortality from any cause.
At baseline, average HbA1c was 7.5%. After the first six months mean HbA1c decreased to 7% in the intensive control arm and to 7.3% in the standard control arm, according to Chalmers. After 36 months, mean HbA1c was lower in the intensive-control group (6.5%) compared with the standard control group (7.3%).
These latest results show that the benefits of tight glucose control and BP lowering are both independent and fully additive, according to a press release. – by Tara Grassia
The new information is that the combination of better glycemic and hypertensive control had a complementary effect on renal disease, cardiovascular death and total mortality. Therefore, we should not abandon glycemic control in patients with long-standing diabetes and should simply control glycemia to levels that will not induce severe or frequent hypoglycemia. This level will vary with the type of medication being utilized and the longevity of diabetes. Hypoglycemia has the potential through stimulation of the sympathetic nervous system and inflammation to increase the frequency of cardiovascular events.
– David S. H. Bell, MB, FACE
University of Alabama School of Medicine
For more information:
- Chalmers J. New results from the ADVANCE trial. Presented at: the 44th Annual Meeting of the European Association for the Study of Diabetes; Rome; Sept. 7-11, 2008.