Routine BP lowering plus intensive glucose control produced additional benefits for vascular outcomes in type 2 diabetes

New analyses from the ADVANCE trial reveal independent effects of routine blood pressure lowering and intensive glucose control for patients with type 2 diabetes; however, combination treatment was associated with additional reductions in clinically relevant mortality and renal and vascular outcomes.

ADVANCE was a multicenter, factorial, randomized trial that enrolled 11,140 patients with type 2 diabetes. Researchers randomly assigned patients to perindopril/indapamide vs. placebo and intensive glucose control with a gliclazide MR-based regimen vs. standard glucose control.

As previously reported in Endocrine Today, ADVANCE data demonstrated independent vascular benefits of BP lowering with perindopril/indapamide after 4.3 years of follow-up, and of intensive glucose control with a gliclazide MR-based regimen after five years of follow-up.

New analyses

For the current analyses, researchers assessed the independent and additive benefits of BP-lowering treatment and intensive glucose control on vascular outcomes in ADVANCE participants.

During 4.3 years of follow-up, the researchers observed no interaction between the effects of routine BP lowering and intensive glucose control for any prespecified clinical outcomes (P>.1 for all). The separate effects of the two interventions on renal outcomes and death appeared to be additive, according to log scale results.

Combination BP lowering and intensive glucose control reduced the risk for new onset microalbuminuria by 26%, new onset macroalbuminuria by 54% and new or worsening nephropathy by 33% compared with neither treatment. Patients assigned to combination treatment also had an 18% reduced risk for all-cause death (P=.04).

“In the present analyses we show that the combined effect of both treatments was at least as great as the effect of either treatment alone for all clinical outcomes and appeared to be greater for some,” the researchers concluded. “This suggests that the multifactorial management of type 2 diabetes should incorporate routine BP lowering and more intensive glucose control to reduce the burden of adverse clinical sequelae in patients with diabetes.”

Zoungas S. Diabetes Care. 2009;32:2068-2074.