Rahman F, et al. - Researchers investigated the impact of baseline blood pressure (BP) levels or cardiovascular disease (CVD) risk on the advantages and risks of intensified antihypertensive therapy in patients with diabetes mellitus. In all, they found that more intensive BP therapy benefitted adults with diabetes mellitus, even at BP levels and CVD risk that some guidelines do not currently recommend for intervention.

Methods

• In the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial, a total of 10,948 people with diabetes mellitus who were at moderate-to-high risk were examined.
• The investigators used Cox models to determine the modification effect of baseline BP category or CVD risk on outcomes of combination perindopril-indapamide treatment vs placebo.

Results

• Participants were followed-up for 4.3 years.
• An attenuation in mortality and major vascular (macrovascular or microvascular) events was observed in relation to treatment with perindopril-indapamide vs placebo.
• These effects did not differ, irrespective of baseline systolic BP, diastolic BP, or if 10-year CVD risk was ≥ 20% or < 20%.
• Across subgroups defined by baseline BP and CVD risk, statistically consistent impact of randomized therapy on discontinuation of treatment due to cough or hypotension/dizziness, was evident.