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Diabetes and Cardiovascular Risk
Figure 1: Blood Pressure Figure 3: Glycemic Control
10.0165
Average BP
155 9.5
during follow-up
Systolic
145
9.0140.3mmHg
134.7mmHg Mean HbA
135 1c
8.5
at final visit
Δ 5.6mmHg (95% CI 5.2–6.0); p<0.001
125 (%)
8.0
1c
115
7.5
7.3%
105
7.0
Δ 0.67% (95% CI 0.64–0.70); p<0.001
Mean HbA95
6.5 6.5%
85
6.0
Diastolic
77.0mmHg
75
Mean blood pressure (mmHg)
74.8mmHg
5.5Δ 2.2mmHg (95% CI 2.0–2.4); p<0.001
65
5.0
R612 18 24 30 36 42 48 54 60
0612 18 24 30 36 42 48 54 60 66
Follow-up (months)
Follow-up (months)
Placebo
Standard
Perindopril/indapamide
Intensive
Mean systolic and diastolic blood pressure during run-in on active treatment and after
Glycemic control at baseline and during follow-up, according to glucose control strategy, in the
randomization to active treatment or placebo in the blood pressure-lowering arm of the 2
ADVANCE trial.
1
ADVANCE trial.
Figure 2: Major Results from the ADVANCE Trial
Effects of Blood Pressure Lowering (ΔBP = 5.6/2.2mmHg)
Number of Events
Per/Ind Placebo Favors Favors Relative Risk
(n=5,569) (n=5,571) Per/Ind Placebo Reduction (95% CI)
Primary End-points
Combined macro + micro 861 938 9% (0 to 17)
Macrovascular events 480 520 8% (-4 to 19)
Microvascular events 439 477 9% (-4 to 20)
Mortality
All-cause death 408 471 14% (2 to 25)
Cardiovascular death 211 257 18% (2 to 32)
Renal End-points
New/worsening nephropathy 181 216 18% (-1 to 32)
New microalbuminuria 1,094 1,317 21% (14 to 27)
New macroalbuminuria 114 163 31% (12 to 46)
0.5 1.0 2.0
Hazard ratio
Effects of Blood Glucose Lowering (ΔHbA
1c
= 0.7%)
Number of Events
Intensive Standard Favors Favors Relative Risk
(n=5,569) (n=5,571) Intensive Standard Reduction (95% CI)
Primary End-points
Combined macro + micro 1,009 1,116 10% (2 to 18)
Macrovascular events 557 590 6% (-6 to 16)
Microvascular events 526 605 14% (3 to 23)
Mortality
All-cause death 498 533 7% (-6 to 17)
Cardiovascular death 253 289 12% (-4 to 26)
Renal End-points
New/worsening nephropathy 230 292 21% (7 to 34)
New microalbuminuria 1,318 1,434 9% (2 to 15)
New macroalbuminuria 114 163 31% (13 to 45)
0.5 1.0 2.0
Per/Ind = perindopril/indapamide.
Hazard ratio
interval [CI] 0–17; p=0.043). The effects on major macrovascular events significant (see Figure 2).
1
Among those on active treatment, there was
considered separately were of similar magnitude but not statistically a 14% (95% CI 2–25; p=0.025) reduction in all-cause mortality, driven by
96 US ENDOCRINOLOGY
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