T2D: intensive BP control with fixed regimen offers benefit

  • Rahman F & al.
  • Hypertension
  • 29 Apr 2019

  • International Clinical Digest
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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 (
  • 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.