Effects of blood pressure lowering on cardiovascular outcomes in different cardiovascular risk groups among participants with type 2 diabetes.
OBJECTIVE
To asses differences in treatment effects of a fixed combination of perindopril-indapamide on major clinical outcomes in patients with type 2 diabetes across subgroups of cardiovascular risk.


METHODS
11,140 participants with type 2 diabetes, from the ADVANCE trial, were randomized to perindopril-indapamide or matching placebo. The Framingham equation was used to calculate 5-year CVD risk and to divide participants into two risk groups, moderate-high risk (<25% and no history of macrovascular disease), very high risk (>25% and/or history of macrovascular disease). Endpoints were macrovascular and microvascular events.


RESULTS
The mean age of participants was 66 years (42.5% female). 1000 macrovascular and 916 microvascular events were recorded over follow-up of 4.3 years. Relative treatment effects were similar across risk groups, (all P-values for heterogeneity ≥0.38). Hazard ratios for combined macro- and microvascular events were 0.89 (0.77-1.03) for the moderate-high risk and 0.92 (0.81-1.03) for the very high risk. Absolute treatment effects tended to be greater in the high risk groups although differences were not statistically significant (P>0.05).


CONCLUSIONS
Relative effects of blood pressure lowering with perindopril-indapamide on cardiovascular outcomes were similar across risk groups whilst absolute effects trended to be greater in the high risk group.
The George Institute for Global Health, University of Sydney, Sydney, Australia.
Susan
S
van Dieren
Andre P
AP
Kengne
John
J
Chalmers
Joline W J
JW
Beulens
Mark E
ME
Cooper
Diederick E
DE
Grobbee
Stephen
S
Harrap
Giuseppe
G
Mancia
Bruce
B
Neal
Anushka
A
Patel
Neil
N
Poulter
Yvonne T
YT
van der Schouw
Mark
M
Woodward
Sophia
S
Zoungas
D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000503:physiopathology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000503:physiopathology / Q000517:prevention & control*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007190:Indapamide / Q000008:administration & dosage*; D008297:Male; D016017:Odds Ratio; D020913:Perindopril / Q000008:administration & dosage*; D012307:Risk Factors; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D004338:Drug Combinations; C494243:indapamide, perindopril drug combination; D007190:Indapamide; D020913:Perindopril