Nuevas perspectivas en el tratamiento del paciente diabético. Estudio ADVANCE

Objectives: The ADVANCE study was designed to determine the effect of a routine reduction in blood pressure in major vascular events, as evaluation criteria, in high-risk individuals with type 2 diabetes, independently of initial blood pressure and of the use of other antihypertensive drugs, including ACE inhibitors. Methods: A random distribution of 11,140 high-risk individuals with type 2 diabetes was made between a fixed combination of perindopril-indapamide and the corresponding placebo, without interrupting the already established treatment of the patients. The two primary evaluation criteria were combination of macrovascular events and major microvascular events. Results: The reduction of blood pressure in the participants assigned to the active treatment was 5.6/2.2 mmHg greater than that observed in the placebo group. Active treatment reduced the risk of a major macrovascular or microvascular event by 9% (p = 0.041) and give rise to a reduction of 14% (p = 0.025) in all-cause mortality and a reduction of 18% (p = 0.027) in cardiovascular caused mortality. Reductions of 14% (p = 0.02) was obtained in total coronary events and 21% (p < 0.0001) in total renal events. Treatment was well tolerated during an average follow-up of 4.3 years. Conclusions: A routine treatment with a fixed combination of perindopril and indapamide decreased the risks of death and major vascular events, independently of the grade of initial blood pressure and of the concomitant treatments received. The results indicate that one death every 5 years would be avoided for each 79 patients treated in this way.