- 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.”
- 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 (
- No statistically significant findings of hypotension, dizziness leading to permanent discontinuation with lower baseline BP or by 10-year ASCVD risk.
- 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.
- 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.