http://www.theheart.org/web_slides/1135309.do A study on Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients (ADVANCE)

1. ADVANCE (Effects of a fixed combination
of perindopril and indapamide on
macrovascular and microvascular
outcomes in patients with type 2 diabetes
mellitus)

2. ADVANCE (Effects of a fixed combination of perindopril and
indapamide on macrovascular and microvascular outcomes in
patients with type 2 diabetes mellitus)
S MacMahon (University of Sydney, Australia)
European Society of Cardiology Congress 2007
• Background:
BP is an important determinant of the risks of macrovascular and
microvascular complications of type 2 diabetes, but traditional BP goals
neglect diabetic patients without what is typically defined as hypertension
• Population and treatment:
11 140 type 2 diabetes patients randomized to fixed-dose
perindopril/indapamide (2 mg/0.625 mg) or matching placebo in addition to
current therapy–after three months, the dose of both agents was doubled
• Primary outcome:
Composites of major macrovascular and microvascular events, defined as
death from CV disease, nonfatal stroke or nonfatal MI, and new or worsening
renal or diabetic eye disease

3. ADVANCE: Results
• The relative risk of a major macrovascular or microvascular event was significantly
reduced by 9% in the active group vs placebo after a mean of 4.3 years
ADVANCE study major results
End point Active Control Hazard ratio 95% CI p
(n=5569), % (n=5571), %
Major macrovascular or 15.5 16.8 0.91 0.83–1.00 0.04
microvascular event
Macrovascular event 8.6 9.3 0.92 0.81–1.04 0.16
Microvascular event 7.9 8.6 0.91 0.80–1.04 0.16
CV death 3.8 4.6 0.82 0.68–0.98 0.03
Death from any cause 7.3 8.5 0.86 0.75–0.98 0.03

4. ADVANCE: Commentary*
"This is a very important study. It supports the idea that we can achieve lower
mortality rates with lower blood pressures in diabetic patients."
- Dr Raymond Gibbons
”Although the guidelines do now recommend that blood pressure be lowered to
130/80 in this population, until now we did not have good evidence for this systolic
pressure. So that is why this trial is important for me. I see it as providing that
evidence."
- Dr Sydney Smith
*All comments from ADVANCE reinforces message to aggressively treat blood pressure in diabetics
(http://www.theheart.org/article/809087.do)

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