Protection of patients with diabetes, with or without hypertension: implications of ADVANCE for clinical practice.
Difficulties in achieving a reduction in morbidity and mortality in patients with diabetes are a result of the complexity of the disease and its intertwined relationship with hypertension and renal impairment. In the recently published Action in Diabetes and Vascular disease: PreterAx and DiamicroN-MR Controlled Evaluation (ADVANCE) trial, treatment of patients with diabetes with the fixed combination perindopril/indapamide on top of background treatments provided clinically and statistically significant reductions in blood pressure (from 145/81 to 136/73 mmHg), all-cause mortality (-14%), cardiovascular mortality (-18%), major cardiovascular events (-9%), renal events (-21%) and new-onset microalbuminuria (-21%) when compared with placebo. As the ADVANCE trial included both hypertensive and normotensive patients, its results suggest that systematically treating all patients with diabetes with perindopril/indapamide, independently of their baseline blood pressure, may have significant long-term value that can be explained partly by the reversal of end-organ damage to the kidney and the heart. Considering that patients with both hypertension and diabetes are characterized by generalized macro- and microvascular disease, the results of the ADVANCE trial, taken together with results of other perindopril/indapamide hypertension studies, support a broad use of perindopril/indapamide treatment for the long-term improvement of prognosis in hypertensive patients as well as in patients with diabetes.
Mancia
Giuseppe
G
Clinica Medica, Department of Medicine and Prevention, San Gerardo Hospital, University of Milan-Bicocca, Monza, Milan, Italy. giuseppe.mancia@unimib.it
Grassi
Guido
G
D001794:Blood Pressure; D003920:Diabetes Mellitus / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D007190:Indapamide / Q000008:administration & dosage / Q000627:therapeutic use; D020913:Perindopril / Q000008:administration & dosage / Q000627:therapeutic use
D007190:Indapamide; D020913:Perindopril