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ADVANCE: Joint BP-lowering and intensive glucose control reduced risk for nephropathy by 33%
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Renal Week 2008
PHILADELPHIA — New analysis of findings from the ADVANCE trial demonstrate that combined use of blood pressure-lowering with perindopril/indapamide and intensive glucose control with a gliclazide MR-based regimen provide additional clinical benefits for patients with type 2 diabetes.
Initial ADVANCE data revealed separate benefits of BP-lowering and intensive glucose control in patients with type 2 diabetes (n=11,140). Vlado Perkovic, MBBS, PhD, and colleagues presented data on the effects of joint intervention at Renal Week 2008.
“The joint effect of the two treatment options do provide very substantial benefits, particularly for the kidney,” said Perkovic, co-director of the Renal Division at The George Institute for International Health in Sydney, Australia.
During a mean 4.3 years of follow-up, patients randomized to both BP-lowering and intensive glucose control experienced a 33% risk reduction in new or worsening nephropathy (P=.005). Further, these patients experienced a 54% risk reduction in new onset macroalbuminuria (P<.0001) and a 26% risk reduction in new onset microalbuminuria (P<.001) compared with patients who received neither intervention.
Combined intervention was also associated with a 24% reduced risk for cardiovascular death (P=.04) and 18% reduced risk for all-cause mortality (P=.04).
By applying the joint intervention to half of the people with type 2 diabetes around the world, “we could prevent 2 million deaths over the next five years,” Perkovic said. – by Katie Kalvaitis
ADVANCE was a well-designed study and this was a nice review that showed the importance of strict control of BP and blood glucose, which each independently affected the outcome in a positive way. It wasn’t like you had to strictly control BP or blood glucose and have one affect the other; both interventions had independent positive effects. We all know this, but this was one of the first studies to really dissect the difference and show the independent positive effects.
– Frederick J. Kaskel, MD, PhD
Director, Pediatric Nephrology, Children’s Hospital at Montefiore
For more information:
- Perkovic V. LB-002. Presented at: Renal Week 2008, American Society of Nephrology 41st Annual Meeting and Scientific Exposition; Nov. 4-9, 2008; Philadelphia.