Effects of blood pressure lowering on cardiovascular outcomes in different cardiovascular risk groups among participants with type 2 diabetes

Susan van Dieren, Andre P. Kengne, John Chalmers, Joline W J Beulens, Mark E. Cooper, Diederick E. Grobbee, Stephen Harrap, Giuseppe Mancia, Bruce Neal, Anushka Patel, Neil Poulter, Yvonne T. van der Schouw, Mark Woodward, Sophia Zoungas

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: 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/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.

Original languageEnglish
Pages (from-to)83-90
Number of pages8
JournalDiabetes Research and Clinical Practice
Volume98
Issue number1
DOIs
Publication statusPublished - Oct 2012

Keywords

  • ADVANCE trial
  • Blood pressure
  • Cardiovascular disease
  • Coronary heart disease
  • Diabetes mellitus
  • Framingham
  • Mortality
  • Risk groups
  • Risk scores
  • Type 2 diabetes

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine
  • Endocrinology

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