Benefit of antihypertensive treatment greatest in Type 2 diabetics with advanced CKD
MedWire News: An analysis of the ADVANCE trial shows that treatment with fixed-combination perindopril plus indapamide is most effective for reducing cardiovascular (CV) and renal outcomes versus placebo in patients with Type 2 diabetes and stage 3 or above chronic kidney disease (CKD).
The ADVANCE (Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation) trial tested the effects of treatment with perindopril/indapamide (4.00/1.25 mg/day) versus placebo (1:1 allocation) on CV and renal outcomes in 10,640 individuals with Type 2 diabetes at increased CV risk.
At baseline 6125, 2482, and 2033 participants had no CKD, CKD stage 1 or 2, and CKD stage 3 or above, respectively.
Writing in the European Heart Journal, Vlado Perkovic (University of Sydney, Australia) and team found that after a mean 4.3 years of follow-up, perindopril/indapamide treatment versus placebo reduced average systolic and diastolic blood pressure in the corresponding groups by 6.1/2.4, 5.3/2.1, and 4.5/1.8 mmHg.
Relative reductions in risk for major CV (CV death, myocardial infarction, or stroke) or renal events were similar across all CKD groups and ranged from 2–18%.
However, when patients with CKD stage 3 or above were compared with those who had no CKD at baseline, the absolute treatment effect of perindopril/indapamide on major CV events was doubled.
For every 1000 patients with CKD stage 3 or above treated for 5 years, perindopril/indapamide prevented 12 CV events compared with 6 in patients with no CKD at baseline.
“The relative treatment benefits of routine administration of a fixed combination of perindopril/indapamide in patients with Type 2 diabetes on renal and cardiovascular outcomes are consistent and not materially modified by the stage of CKD at baseline,” write Perkovic and colleagues. “The absolute benefits of treatment are, however, greater in people with CKD.”
They conclude: “This highlights the importance of blood pressure-lowering therapy in preventing renal and cardiovascular complications in this high-risk population.”
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By Helen Albert