Effects of blood pressure lowering on cardiovascular outcomes in different cardiovascular risk groups among participants with type 2 diabetes

Susan van Dieren, Andre P. Kengne, John Chalmers, Joline W.J. Beulens, Mark E. Cooper, Diederick E. Grobbee, Stephen Harrap, Giuseppe Mancia, Bruce Neal, Anushka Patel, Neil Poulter, Yvonne T. van der Schouw, Mark Woodward, Sophia Zoungas*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Aims: To asses differences in treatment effects of a fixed combination of perindopril-indapamide on major clinical outcomes in patients with type 2 diabetes across subgroups of cardiovascular risk. Methods: 11,140 participants with type 2 diabetes, from the ADVANCE trial, were randomized to perindopril-indapamide or matching placebo. The Framingham equation was used to calculate 5-year CVD risk and to divide participants into two risk groups, moderate-high risk (<25% and no history of macrovascular disease), very high risk (>25% and/or history of macrovascular disease). Endpoints were macrovascular and microvascular events. Results: The mean age of participants was 66 years (42.5% female). 1000 macrovascular and 916 microvascular events were recorded over follow-up of 4.3 years. Relative treatment effects were similar across risk groups, (all P-values for heterogeneity ≥0.38). Hazard ratios for combined macro- and microvascular events were 0.89 (0.77-1.03) for the moderate-high risk and 0.92 (0.81-1.03) for the very high risk. Absolute treatment effects tended to be greater in the high risk groups although differences were not statistically significant (P>0.05). Conclusions: Relative effects of blood pressure lowering with perindopril-indapamide on cardiovascular outcomes were similar across risk groups whilst absolute effects trended to be greater in the high risk group.

Original languageEnglish
Pages (from-to)83-90
Number of pages8
JournalDiabetes Research and Clinical Practice
Issue number1
Publication statusPublished - 1 Oct 2012

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