Effects of perindopril-indapamide on left ventricular diastolic function and mass in patients with type 2 diabetes: The ADVANCE Echocardiography Substudy

Robert Doughty, Gillian Whalley, Greg Gamble, John Baker, John Chalmers, Mark Cooper, Kennedy Cruickshank, Peter Dixon, Peter Dunne, David Eccleston, George Jerums, Richard Luke, Barry McGrath, Christopher Nolan, Anushka Patel, Neil Poulter, Patrick Phillips, Russell Scott, Jasvinder Singh, Robert SmithAlice Stanton, Michael Suranyi, Simon Thom, Mark Woodward, G Jerums, Helen Walsh, Stephen MacMahon, Eleuterio Ferrannini, Paul Glasziou, Diederick Grobbee, Pavel Hamet, Stephen Harrap, S Heller, Lisheng Liu, Giuseppe Mancia, Michel Marre, Carl Mogensen, Bruce Neal, Chang Yu Pan, A Rodgers, Bryan Williams, Carolyn Jacklin, Karen McNeil, Piyush Srivastava, Todor Arsov, Manuel Correcha, Mary Hines, F Margrie, U Musial, Nikolai Petrovsky, Diego Silva, Luis Socha, Jeffrey Sutherland, K Gordijn, K Grigarius, Christian Meyer, Rinki Singh, Helena Teede, J Wong, A Yeap, Sophia Zoungas, Christine Allman, Josephine Chow, M Curtale, Dominic Leung, Betsy Malkus, Glenda Rayment, Timothy Spicer, M Wong, Sharon Mackintosh, Cathy Miller, P Phillips, Stephen Stranks, Paul Taylor, Scott Baker, Logan Bittinger, R Cotton, Penelope Harvey, Bruce Jackson, L Laqui, V Lawlor, Siaw-Teng Liaw, Christopher Neil, M Park, Erosha Premaratne, Felicity Pyrlis, Gloria Rudge, J Cruickshank, Moulinath Banerjee, John Collins, J Dunkerley, Cheryce Harrison, Kay Hart, Mark Holland, Rajdeep Khattar, Manju Luckson, Sylvia Shaw, Thomas Wood, Robert Elkeles, Jamil Mayet, Andrew Sharp, Andrew Whitehouse, Jean Mackay, J Bunker, W Callister, Cecil Coghlan, Raul Fernandez, Vicki Gordon, Jane Harman, Narvada Jugnee, L Knisley, Anne McKerracher, Simon Mitchell, Sinead Murphy, Alastair Strain, O Trainor, Basel Aloul, Cathal Collier, Eamon Dolan, Christopher Foley, Barbara Gallagher, B Gusau, L Hacke, E Ho, Simon Lyons, Brian Maguire, Tim Morgan, Christopher Thompson, M Twohill, Christopher Florkowski, A Kwon, Roberta McEwan, Patrice McGregor, Margaret Milne, Christopher Strey, Richard Troughton, Gordon Brown, V D'Ath, Jane Kenyon, Robert Leikis, Richard Clarke, Ajith Dissanayake, S Gunatilaka, Julia Leary, Ilene Rosen, M Te Whiu, H Walsh, Stephanie Austin, Robert Clarke, L Howitt, Gina Ward, G Carswell, Peter Hansen, Mary Lane, D Nesdale, Peter Dunn, Raewyn Fisher, Elham Reda, A Johnstone, Lynne McLeod, F Bartley, Alyson Waterman, Juliet Jensen, Douglas Owens, Tracy Clarke, P Cresswell, Agnes Ferguson, Mark Simmonds, Stephan Winter

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    Abstract

    Background: The Action in Diabetes and Vascular Disease (ADVANCE) Study demonstrated that a fixed combination of perindopril and indapamide reduced the risk of major vascular events and mortality in patients with type 2 diabetes. This Echocardiographic Substudy was designed to determine the effects of this treatment on left ventricular diastolic function and left ventricular mass. Methods: Five hundred and fifty-five patients entering ADVANCE underwent quantitative echocardiography prior to randomization and after 6 months and 4 years of treatment with perindopril-indapamide or placebo. Main end points were left ventricular diastolic function (ratio of mitral E velocity/early medial mitral annular tissue Doppler velocity, E/Em, and left atrial volume index) and left ventricular mass index. Results: Overall, blood pressure was reduced in the perindopril-indapamide group compared with placebo. E/Em and left atrial volume index both increased over the 4 years. There was no effect of perindopril-indapamide on E/Em, although there was a small attenuation of the increase in left atrial volume index with active treatment. Left ventricular mass index was reduced by 2.7 g/m with active treatment (95% confidence interval -5.0 to -0.1, P = 0.04). Conclusion: Compared with placebo, the perindopril-indapamide combination reduced blood pressure and left ventricular mass in patients with diabetes, but did not improve left ventricular diastolic function. Left ventricular diastolic function worsened in both groups over 4 years, despite blood pressure reduction and reduction in left ventricular mass. Improving left ventricular diastolic function remains a challenge in patients with diabetes.

    Original languageEnglish
    Pages (from-to)1439-1447
    Number of pages9
    JournalJournal of Hypertension
    Volume29
    Issue number7
    DOIs
    Publication statusPublished - 2011

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