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Follow-up of blood-pressure lowering and glucose control in type 2 diabetes.
Molecular and Cellular Therapeutics Articles
  • Sophia Zoungas
  • John Chalmers
  • Bruce Neal
  • Laurent Billot
  • Qiang Li
  • Yoichiro Hirakawa
  • Hisatomi Arima
  • Helen Monaghan
  • Rohina Joshi
  • Stephen Colagiuri
  • Mark E Cooper
  • Paul Glasziou
  • Diederick Grobbee
  • Pavel Hamet
  • Stephen Harrap
  • Simon Heller
  • Liu Lisheng
  • Giuseppe Mancia
  • Michel Marre
  • David R Matthews
  • Carl E Mogensen
  • Vlado Perkovic
  • Neil Poulter
  • Anthony Rodgers
  • Bryan Williams
  • Stephen MacMahon
  • Anushka Patel
  • Mark Woodward
  • ADVANCE-ON
  • Alice Stanton, Royal College of Surgeons in Ireland
Peer Reviewed
1
Document Type
Article
Publication Date
9-10-2014
Keywords
  • Antihypertensive Agents,
  • Blood Glucose,
  • Diabetes Mellitus,
  • Type 2,
  • Drug Combinations,
  • Female,
  • Follow-Up Studies,
  • Gliclazide,
  • Hemoglobin A,
  • Glycosylated,
  • Humans,
  • Hypertension,
  • Hypoglycemic Agents,
  • Indapamide,
  • Male,
  • Middle Aged,
  • Perindopril,
  • Risk Factors
Comments

Alice Stanton is a member of the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation Observational Study (ADVANCE-ON) Collaborative Group.

This article is also available at http://www.nejm.org/doi/full/10.1056/NEJMoa1407963

Abstract

BACKGROUND: In the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) factorial trial, the combination of perindopril and indapamide reduced mortality among patients with type 2 diabetes, but intensive glucose control, targeting a glycated hemoglobin level of less than 6.5%, did not. We now report results of the 6-year post-trial follow-up.

METHODS: We invited surviving participants, who had previously been assigned to perindopril-indapamide or placebo and to intensive or standard glucose control (with the glucose-control comparison extending for an additional 6 months), to participate in a post-trial follow-up evaluation. The primary end points were death from any cause and major macrovascular events.

RESULTS: The baseline characteristics were similar among the 11,140 patients who originally underwent randomization and the 8494 patients who participated in the post-trial follow-up for a median of 5.9 years (blood-pressure-lowering comparison) or 5.4 years (glucose-control comparison). Between-group differences in blood pressure and glycated hemoglobin levels during the trial were no longer evident by the first post-trial visit. The reductions in the risk of death from any cause and of death from cardiovascular causes that had been observed in the group receiving active blood-pressure-lowering treatment during the trial were attenuated but significant at the end of the post-trial follow-up; the hazard ratios were 0.91 (95% confidence interval [CI], 0.84 to 0.99; P=0.03) and 0.88 (95% CI, 0.77 to 0.99; P=0.04), respectively. No differences were observed during follow-up in the risk of death from any cause or major macrovascular events between the intensive-glucose-control group and the standard-glucose-control group; the hazard ratios were 1.00 (95% CI, 0.92 to 1.08) and 1.00 (95% CI, 0.92 to 1.08), respectively.

CONCLUSIONS: The benefits with respect to mortality that had been observed among patients originally assigned to blood-pressure-lowering therapy were attenuated but still evident at the end of follow-up. There was no evidence that intensive glucose control during the trial led to long-term benefits with respect to mortality or macrovascular events. (Funded by the National Health and Medical Research Council of Australia and others; ADVANCE-ON ClinicalTrials.gov number, NCT00949286.).

Disciplines
PubMed ID
25234206
DOI Link
10.1056/NEJMoa1407963
Creative Commons License
Creative Commons Attribution 4.0
Citation Information
Zoungas S, Chalmers J, Neal B, et al. Follow-up of blood-pressure lowering and glucose control in type 2 diabetes. New England Journal of Medicine. 2014;371(15):1392-406.