September 1, 2014

The benefits of the ADVANCE-ON Trial – blood pressure lowering with perindopril-indapamide in patients with type 2 diabetes – were successfully sustained six year after the completion of the initial study, according to post-trial follow-up results presented Sept. 1 at ESC Congress 2014.When it was first released, the ADVANCE trial was a 2×2 factorial trial whose blood pressure lowering arm demonstrated that a combination of perindopril-indapamide reduced all-cause mortality by 14 percent, cardiovascular death by 18 percent and vascular events by nine percent in patients with type 2 diabetes.

The six year follow-up results showed that baseline characteristics of the 11,140 originally randomized patients, and the 8,494 who contributed to the post-trial were similar. Any differences in blood pressure between the two groups vanished by the first post-randomization visit. Reductions in cardiovascular death and all-cause death documented during the active treatment were sustained to the end of the post-trial follow-up (hazard ratios [95 percent confidence intervals] 0.91[0.84-0.99], p=0.03 and 0.88[0.77-0.99], p=0.04) respectively, but were diminished. Additionally, the reductions in major macrovascular events were not significant (0.92[0.85-1.00], p=0.06).

Based on their findings, the investigators conclude that blood pressure lowering with perindopril-indapamide in patients with type 2 diabetes confers real benefits with reductions in all cause and cardiovascular mortality that are still evident, albeit attenuated, six years after randomized treated ceased. They note the importance of maintaining blood pressure lowering in both the short- and longer-term in order to generate the best possible reductions in mortality and major cardiovascular events in this particular population.