Fixed-dose combination of perindopril and indapamide reduces diabetes mortality
Giving a fixed dose combination antihypertensive to patients with type 2 diabetes, regardless of blood pressure or existing treatment, cuts the risk of cardiovascular death by 18 per cent, according to a study of over 11,000 patients.
Although the investigators said the data justify giving this fixed-dose
combination drug (Coversyl Plus; perindopril 4mg and indapamide 1.25mg)
to all diabetes patients, other specialists said it simply adds to the
evidence that blood pressure in diabetes should be treated down to the
130/80mmHg target now recommended in many national guidelines, including
the UK’s.
Data from the ADVANCE study were presented at this week’s European
Society of Cardiology meeting in Vienna and published online simultaneously
in The Lancet (2 September 2007).
The study involved 11,140 patients with type 2 diabetes from 20 countries,
including 1,135 UK patients, randomised to receive a fixed dose of the
angiotensin-converting enzyme inhibitor perindopril and the thiazide
diuretic indapamide or placebo.
Average blood pressure at baseline was 145/81mmHg, reduced to 135/75mmHg
in the active-treatment group compared with 140/77mmHg in the placebo
group over the 4.3 years of follow-up.
The relative risk of death from cardiovascular disease in the intervention
group was reduced by 18 per cent (P=0.03) and death from any cause was
down by 14 per cent (P=0.03).
John Chalmers, co-principal investigator of the study and chairman of
the study group at The George Institute for International Health in Sydney,
Australia, said: “The simplicity of a single combination tablet
given to all diabetic patients will make a huge difference in lowering
blood pressures across the board. It would be a bit like taking an aspirin
a day if you have CHD.”
But discussing the results, Sidney Smith, director of the Centre of Cardiovascular
Science at the University of Carolina, was more cautious and said: “It
seems that the typical person who benefited in this trial was a 55-year-old
who had had diabetes for several years and had a [baseline] systolic
blood pressure of about 145mmHg.
“I can’t see much evidence that a 35-year-old diabetic with
blood pressure of 130/80mmHg would benefit much from more drug therapy.”
Following the presentation ESC fellow and Berkshire GP George Kassianos
said: “These data do suggest that we need to treat blood pressure
in diabetic patients below the current [GP] QOF target and doing so would
have large benefits.
“But the evidence for that is using this fixed-dose combination,
not by intensifying other treatments.”
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