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Dr. John P. Chalmers
Prof. Lars Ryden,
By John P Chalmers, (Sydney, Australia)View Discussant report by Lars Ryden, FESC
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List of Authors: John Chalmers 1() on behalf of the ADVANCE-ON Collaborative Group (1) The George Institute for Global Health, Sydney, Australia
BackgroundThe Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial, was a 2x2 factorial trial whose blood pressure lowering arm demonstrated that the combination of perindopril-indapamide reduced all-cause mortality by 14%, cardiovascular death by 18% and vascular events by 9% in patients with type 2 diabetes. We present here the results of post-trial follow-up, conducted to determine whether these benefits were sustained.MethodsSurvivors, previously randomly assigned to perindopril-indapamide or placebo were invited to post-trial follow-up. Primary outcomes were all-cause mortality and major macrovascular events (myocardial infarction, stroke and death from a cardiovascular cause). Effects on pre-specified endpoints were compared according to previous randomised treatment. (ClinicalTrials.Gov NCT 0094286)ResultsBaseline characteristics of 11140 patients originally randomised, and 8494 who contributed to post-trial follow-up for a median of 5.9 years, were similar. Differences in blood pressure between the two groups disappeared by the first post-randomisation visit. The reductions in all-cause death and cardiovascular death recorded during active treatment were sustained to the end of post-trial follow-up (hazard ratios [95% confidence intervals] 0.91[0.84-0.99], p=0.03 and 0.88[0.77-0.99], p=0.04) respectively, but were diminished. The reductions in major macrovascular events were not significant (0.92[0.85-1.00], p=0.06)ConclusionsThese results emphasise the importance of active blood pressure lowering in patients with type 2 diabetes in both the short term and the long term in order to maximise survival and cardiovascular protection.
By Lars Ryden, FESC (Stockholm, Sweden)See Presenter abstract
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