A small reduction in blood
pressure produced a significant benefit in the largest study ever done on
the treatment of patients with type 2 diabetes, presented on Sunday in
Vienna at the European Society of Cardiology Congress, and published online
in the Lancet the same day.
Stephen MacMahon, Ph.D., M.P., described the results of ADVANCE, a
randomized, placebo controlled study in which 11,140 patients received
either placebo or a single pill containing a fixed combination of an ACE
inhibitor (perindopril) and a thiazide-like diuretic (indapamide). While
the reduction in blood pressure was modest (an average of 5.6/2.2 mm Hg),
at 4.3 years the treated group had a relative risk reduction of 14 percent
for coronary heart disease events, 18 percent for cardiovascular deaths, 14
percent for deaths of any cause, and 21 percent for developing new or
worsening kidney disease.
Daniel W. Jones, M.D., President of the American Heart Association,
commented, "We spend both great effort and considerable financial resources
in trying to treat diabetes effectively, and here is a simple and
inexpensive way to save lives. Just lower the blood pressure!"
MacMahon calculated that one death could be avoided among every 78
patients treated for five years. Because type-2 diabetes is so common
worldwide, he added that treatment such as this could prevent as many as
1.5 million deaths, even if given to only half of the world's diabetics.
The benefit for treated patients was seen both in the group who began
with blood pressures above 140/90 and those who began at levels below this
cut-off. It was also apparent whether or not patients were also on other
blood- pressure-lowering drugs, statins, ACE inhibitors, and aspirin.
The American Heart Association points out that the majority of deaths
in diabetic patients are due to cardiovascular disease. Dr. Jones added,
"Having diabetes alone elevates an individual's risk to the same level as
having coronary artery disease itself, and this means that we and our
patients must work together to control all risk factors as well as
possible. Diabetic patients should work with healthcare professionals to
assure control of all risk factors including maintaining blood pressure
levels under 130/85."
American Heart Association
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