Follow-up of blood-pressure lowering and glucose control in type 2 diabetes

Sophia Zoungas*, John Chalmers, Bruce Neal, Laurent Billot, Qiang Li, M. Biostat, Yoichiro Hirakawa, Hisatomi Arima, Helen Monaghan, Rohina Joshi, Stephen Colagiuri, Mark E. Cooper, Paul Glasziou, Diederick Grobbee, Pavel Hamet, Stephen Harrap, Simon Heller, Liu Lisheng, Giuseppe Mancia, Michel MarreDavid R. Matthews, Carl E. Mogensen, Vlado Perkovic, Neil Poulter, Anthony Rodgers, Bryan Williams, Stephen MacMahon, Anushka Patel, Mark Woodward

*Corresponding author for this work

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340 Citations (Scopus)

Abstract

BACKGROUND

In the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) factorial trial, the combination of perindopril and indapamide reduced mortality among patients with type 2 diabetes, but intensive glucose control, targeting a glycated hemoglobin level of less than 6.5%, did not. We now report results of the 6-year post-trial follow-up.

METHODS

We invited surviving participants, who had previously been assigned to perindopril-indapamide or placebo and to intensive or standard glucose control (with the glucose-control comparison extending for an additional 6 months), to participate in a post-trial follow-up evaluation. The primary end points were death from any cause and major macrovascular events.

RESULTS

The baseline characteristics were similar among the 11,140 patients who originally underwent randomization and the 8494 patients who participated in the post-trial follow-up for a median of 5.9 years (blood-pressure-lowering comparison) or 5.4 years (glucose-control comparison). Between-group differences in blood pressure and glycated hemoglobin levels during the trial were no longer evident by the first post-trial visit. The reductions in the risk of death from any cause and of death from cardiovascular causes that had been observed in the group receiving active blood-pressure-lowering treatment during the trial were attenuated but significant at the end of the post-trial follow-up; the hazard ratios were 0.91 (95% confidence interval [CI], 0.84 to 0.99; P = 0.03) and 0.88 (95% CI, 0.77 to 0.99; P = 0.04), respectively. No differences were observed during follow-up in the risk of death from any cause or major macrovascular events between the intensive-glucose-control group and the standard-glucose-control group; the hazard ratios were 1.00 (95% CI, 0.92 to 1.08) and 1.00 (95% CI, 0.92 to 1.08), respectively.

CONCLUSIONS

The benefits with respect to mortality that had been observed among patients originally assigned to blood-pressure-lowering therapy were attenuated but still evident at the end of follow-up. There was no evidence that intensive glucose control during the trial led to long-term benefits with respect to mortality or macrovascular events.

Original languageEnglish
Pages (from-to)1392-1406
Number of pages15
JournalNew England Journal of Medicine
Volume371
Issue number15
DOIs
Publication statusPublished - 9 Oct 2014

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    Zoungas, S., Chalmers, J., Neal, B., Billot, L., Li, Q., Biostat, M., Hirakawa, Y., Arima, H., Monaghan, H., Joshi, R., Colagiuri, S., Cooper, M. E., Glasziou, P., Grobbee, D., Hamet, P., Harrap, S., Heller, S., Lisheng, L., Mancia, G., ... Woodward, M. (2014). Follow-up of blood-pressure lowering and glucose control in type 2 diabetes. New England Journal of Medicine, 371(15), 1392-1406. https://doi.org/10.1056/NEJMoa1407963