Combined effects of routine blood pressure lowering and intensive glucose control on macrovascular and microvascular outcomes in patients with type 2 diabetes: New results from the ADVANCE trial. Export

@article{citeulike:5733809, abstract = {OBJECTIVE: To assess the magnitude and independence of the effects of routine blood pressure lowering and intensive glucose control on clinical outcomes in patients with long-standing type 2 diabetes. RESEARCH DESIGN AND METHODS: This was a multicenter, factorial randomized trial of perindopril-indapamide versus placebo (double-blind comparison) and intensive glucose control with a gliclazide MR-based regimen (target A1C <or=6.5\%) versus standard glucose control (open comparison) in 11,140 participants with type 2 diabetes who participated in the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial. Annual event rates and risks of major macrovascular and microvascular events considered jointly and separately, renal events, and death during an average 4.3 years of follow-up were assessed, using Cox proportional hazards models. RESULTS: There was no interaction between the effects of routine blood pressure lowering and intensive glucose control for any of the prespecified clinical outcomes (all P > 0.1): the separate effects of the two interventions for the renal outcomes and death appeared to be additive on the log scale. Compared with neither intervention, combination treatment reduced the risk of new or worsening nephropathy by 33\% (95\% CI 12-50\%, P = 0.005), new onset of macroalbuminuria by 54\% (35-68\%, P < 0.0001), and new onset of microalbuminuria by 26\% (17-34\%). Combination treatment was associated with an 18\% reduction in the risk of all-cause death (1-32\%, P = 0.04). CONCLUSIONS: The effects of routine blood pressure lowering and intensive glucose control were independent of one another. When combined, they produced additional reductions in clinically relevant outcomes.}, author = {Zoungas, Sophia and de Galan, Bastiaan E. and Ninomiya, Toshiharu and Grobbee, Diederick and Hamet, Pavel and Heller, Simon and MacMahon, Stephen and Marre, Michel and Neal, Bruce and Patel, Anushka and Woodward, Mark and Chalmers, John and {ADVANCE Collaborative Group} and Cass, Alan and Glasziou, Paul and Harrap, Stephen and Lisheng, Liu and Mancia, Guiseppe and Pillai, Avinesh and Poulter, Neil and Perkovic, Vlado and Travert, Florence}, citeulike-article-id = {5733809}, citeulike-linkout-0 = {http://dx.doi.org/10.2337/dc09-0959}, citeulike-linkout-1 = {http://care.diabetesjournals.org/content/32/11/2068.abstract}, citeulike-linkout-2 = {http://care.diabetesjournals.org/content/32/11/2068.full.pdf}, citeulike-linkout-3 = {http://view.ncbi.nlm.nih.gov/pubmed/19651921}, citeulike-linkout-4 = {http://www.hubmed.org/display.cgi?uids=19651921}, day = {3}, doi = {10.2337/dc09-0959}, issn = {1935-5548}, journal = {Diabetes care}, keywords = {encdr-journal-club, hyperglycaemia}, month = {November}, number = {11}, pages = {2068--2074}, posted-at = {2009-10-29 23:13:57}, priority = {2}, title = {Combined effects of routine blood pressure lowering and intensive glucose control on macrovascular and microvascular outcomes in patients with type 2 diabetes: New results from the ADVANCE trial.}, url = {http://dx.doi.org/10.2337/dc09-0959}, volume = {32}, year = {2009} }

TY - JOUR ID - citeulike:5733809 L3 - citeulike-article-id:5733809 N2 - OBJECTIVE: To assess the magnitude and independence of the effects of routine blood pressure lowering and intensive glucose control on clinical outcomes in patients with long-standing type 2 diabetes. RESEARCH DESIGN AND METHODS: This was a multicenter, factorial randomized trial of perindopril-indapamide versus placebo (double-blind comparison) and intensive glucose control with a gliclazide MR-based regimen (target A1C <or=6.5%) versus standard glucose control (open comparison) in 11,140 participants with type 2 diabetes who participated in the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial. Annual event rates and risks of major macrovascular and microvascular events considered jointly and separately, renal events, and death during an average 4.3 years of follow-up were assessed, using Cox proportional hazards models. RESULTS: There was no interaction between the effects of routine blood pressure lowering and intensive glucose control for any of the prespecified clinical outcomes (all P > 0.1): the separate effects of the two interventions for the renal outcomes and death appeared to be additive on the log scale. Compared with neither intervention, combination treatment reduced the risk of new or worsening nephropathy by 33% (95% CI 12-50%, P = 0.005), new onset of macroalbuminuria by 54% (35-68%, P < 0.0001), and new onset of microalbuminuria by 26% (17-34%). Combination treatment was associated with an 18% reduction in the risk of all-cause death (1-32%, P = 0.04). CONCLUSIONS: The effects of routine blood pressure lowering and intensive glucose control were independent of one another. When combined, they produced additional reductions in clinically relevant outcomes. IS - 11 JF - Diabetes care SN - 1935-5548 EP - 2074 TI - Combined effects of routine blood pressure lowering and intensive glucose control on macrovascular and microvascular outcomes in patients with type 2 diabetes: New results from the ADVANCE trial. VL - 32 SP - 2068 KW - encdr-journal-club KW - hyperglycaemia AU - Zoungas, Sophia AU - de Galan, Bastiaan AU - Ninomiya, Toshiharu AU - Grobbee, Diederick AU - Hamet, Pavel AU - Heller, Simon AU - MacMahon, Stephen AU - Marre, Michel AU - Neal, Bruce AU - Patel, Anushka AU - Woodward, Mark AU - Chalmers, John AU - Cass, Alan AU - Glasziou, Paul AU - Harrap, Stephen AU - Lisheng, Liu AU - Mancia, Guiseppe AU - Pillai, Avinesh AU - Poulter, Neil AU - Perkovic, Vlado AU - Travert, Florence PY - 2009/11/03/ UR - http://dx.doi.org/10.2337/dc09-0959 ER -