T2D: intensive BP control with fixed regimen offers benefit

Takeaway

• In adults with type 2 diabetes (T2D), intensive BP treatment with a fixed 2-drug regimen appears to offer benefit.

Why this matters

• Because of little to no representation of patients with T2D in major hypertension-related clinical trials (SPRINT, HOPE-3), the optimal BP target in this population has been elusive.
• Results of other trials with this patient group have been mixed.
• Guidelines have largely recommended to “individualize the approach.”

Key results

• Fixed-dose regimen of perindopril-indapamide bested placebo for:
  • Reduced mortality: HR, 0.86 (95% CI, 0.75-0.99); and
  • Major vascular event rates: HR, 0.91 (95% CI, 0.83-0.997).
• Consideration of low baseline BP (<120/<70 mmHg), 10-year atherosclerotic cardiovascular disease (ASCVD) risk (≥20% or <20%) showed no significant influence.
• No statistically significant findings of hypotension, dizziness leading to permanent discontinuation with lower baseline BP or by 10-year ASCVD risk.

Study design

• Post hoc analysis of data from the ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation); n=10,948.
• Funding: NIH; National Health and Medical Research Council of Australia; Servier.

Limitations

• ASCVD risk cutoff was set at 20%, but guidelines recommend pharmacologic therapy with ≥10% risk; it is possible that those at lower risk may not benefit from intensive treatment.