AustralieFrV1, Main, Exploration, bibRecord, 008421

Combined Effects of Routine Blood Pressure Lowering and Intensive Glucose Control on Macrovascular and Microvascular Outcomes in Patients With Type 2 Diabetes: New results from the ADVANCE trial

Identifieur interne : 008421 ( Main/Exploration ); précédent : 008420; suivant : 008422

Combined Effects of Routine Blood Pressure Lowering and Intensive Glucose Control on Macrovascular and Microvascular Outcomes in Patients With Type 2 Diabetes: New results from the ADVANCE trial

Auteurs : Sophia Zoungas [Australie] ; Bastiaan E. De Galan [Australie, Pays-Bas] ; Toshiharu Ninomiya [Australie] ; Diederick Grobbee [Pays-Bas] ; Pavel Hamet [Canada] ; Simon Heller [Royaume-Uni] ; Stephen Macmahon [Australie] ; Michel Marre [France] ; Bruce Neal [Australie] ; Anushka Patel [Australie] ; Mark Woodward [Australie, États-Unis] ; John Chalmers [Australie]

Source :

Diabetes care [ 0149-5992 ] ; 2009.

RBID : Pascal:09-0476530

Descripteurs français

Pascal (Inist)
- Diabète de type 2, Antihypertenseur, Glycémie, Microcirculation, Pronostic, Evolution, Homme, Malade, Résultat, Essai clinique, Endocrinologie, Maladie métabolique, Nutrition.
Wicri :
- topic : Homme, Nutrition.

English descriptors

KwdEn :
- Antihypertensive agent, Clinical trial, Endocrinology, Evolution, Glycemia, Human, Metabolic diseases, Microcirculation, Nutrition, Patient, Prognosis, Result, Type 2 diabetes.

Abstract

OBJECTIVE- To assess the magnitude and independence of the effects of routine blood pressure lowering and intensive glucose control on clinical outcomes in patients with longstanding type 2 diabetes. RESEARCH DESIGN AND METHODS- This was a multicenter, factorial randomized trial of perindopril-indapamide versus placebo (double-blind comparison) and intensive glucose control with a gliclazide MR-based regimen (target A1C ≤6.5%) versus standard glucose control (open comparison) in 11,140 participants with type 2 diabetes who participated in the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial. Annual event rates and risks of major macrovascular and microvascular events considered jointly and separately, renal events, and death during an average 4.3 years of follow-up were assessed, using Cox proportional hazards models. RESULTS - There was no interaction between the effects of routine blood pressure lowering and intensive glucose control for any of the prespecified clinical outcomes (all P > 0.1): the separate effects of the two interventions for the renal outcomes and death appeared to be additive on the log scale. Compared with neither intervention, combination treatment reduced the risk of new or worsening nephropathy by 33% (95% CI 12-50%, P = 0.005), new onset of macroalbuminuria by 54% (35-68%, P < 0.0001), and new onset of microalbuminuria by 26% (17-34%). Combination treatment was associated with an 18% reduction in the risk of all-cause death (1-32%, P = 0.04). CONCLUSIONS- The effects of routine blood pressure lowering and intensive glucose control were independent of one another. When combined, they produced additional reductions in clinically relevant outcomes.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768202

Affiliations:

Le document en format XML

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<author><name sortKey="Patel, Anushka" sort="Patel, Anushka" uniqKey="Patel A" first="Anushka" last="Patel">Anushka Patel</name>
<affiliation wicri:level="4"><inist:fA14 i1="01"><s1>The George Institute for International Health, University of Sydney</s1>
<s2>Sydney, New South Wales</s2>
<s3>AUS</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
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<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
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</inist:fA14>
<country>Australie</country>
<placeName><settlement type="city">Sydney</settlement>
<region type="état">Nouvelle-Galles du Sud</region>
</placeName>
<orgName type="university">Université de Sydney</orgName>
</affiliation>
</author>
<author><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name>
<affiliation wicri:level="4"><inist:fA14 i1="01"><s1>The George Institute for International Health, University of Sydney</s1>
<s2>Sydney, New South Wales</s2>
<s3>AUS</s3>
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<country>Australie</country>
<placeName><settlement type="city">Sydney</settlement>
<region type="état">Nouvelle-Galles du Sud</region>
</placeName>
<orgName type="university">Université de Sydney</orgName>
</affiliation>
<affiliation wicri:level="2"><inist:fA14 i1="08"><s1>Mount Sinai School of Medicine</s1>
<s2>New York, New York</s2>
<s3>USA</s3>
<sZ>11 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
<placeName><region type="state">État de New York</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Chalmers, John" sort="Chalmers, John" uniqKey="Chalmers J" first="John" last="Chalmers">John Chalmers</name>
<affiliation wicri:level="4"><inist:fA14 i1="01"><s1>The George Institute for International Health, University of Sydney</s1>
<s2>Sydney, New South Wales</s2>
<s3>AUS</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>11 aut.</sZ>
<sZ>12 aut.</sZ>
</inist:fA14>
<country>Australie</country>
<placeName><settlement type="city">Sydney</settlement>
<region type="état">Nouvelle-Galles du Sud</region>
</placeName>
<orgName type="university">Université de Sydney</orgName>
</affiliation>
</author>
</analytic>
<series><title level="j" type="main">Diabetes care</title>
<title level="j" type="abbreviated">Diabetes care</title>
<idno type="ISSN">0149-5992</idno>
<imprint><date when="2009">2009</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
<seriesStmt><title level="j" type="main">Diabetes care</title>
<title level="j" type="abbreviated">Diabetes care</title>
<idno type="ISSN">0149-5992</idno>
</seriesStmt>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antihypertensive agent</term>
<term>Clinical trial</term>
<term>Endocrinology</term>
<term>Evolution</term>
<term>Glycemia</term>
<term>Human</term>
<term>Metabolic diseases</term>
<term>Microcirculation</term>
<term>Nutrition</term>
<term>Patient</term>
<term>Prognosis</term>
<term>Result</term>
<term>Type 2 diabetes</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Diabète de type 2</term>
<term>Antihypertenseur</term>
<term>Glycémie</term>
<term>Microcirculation</term>
<term>Pronostic</term>
<term>Evolution</term>
<term>Homme</term>
<term>Malade</term>
<term>Résultat</term>
<term>Essai clinique</term>
<term>Endocrinologie</term>
<term>Maladie métabolique</term>
<term>Nutrition</term>
</keywords>
<keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term>
<term>Nutrition</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en">OBJECTIVE- To assess the magnitude and independence of the effects of routine blood pressure lowering and intensive glucose control on clinical outcomes in patients with longstanding type 2 diabetes. RESEARCH DESIGN AND METHODS- This was a multicenter, factorial randomized trial of perindopril-indapamide versus placebo (double-blind comparison) and intensive glucose control with a gliclazide MR-based regimen (target A1C ≤6.5%) versus standard glucose control (open comparison) in 11,140 participants with type 2 diabetes who participated in the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial. Annual event rates and risks of major macrovascular and microvascular events considered jointly and separately, renal events, and death during an average 4.3 years of follow-up were assessed, using Cox proportional hazards models. RESULTS - There was no interaction between the effects of routine blood pressure lowering and intensive glucose control for any of the prespecified clinical outcomes (all P > 0.1): the separate effects of the two interventions for the renal outcomes and death appeared to be additive on the log scale. Compared with neither intervention, combination treatment reduced the risk of new or worsening nephropathy by 33% (95% CI 12-50%, P = 0.005), new onset of macroalbuminuria by 54% (35-68%, P < 0.0001), and new onset of microalbuminuria by 26% (17-34%). Combination treatment was associated with an 18% reduction in the risk of all-cause death (1-32%, P = 0.04). CONCLUSIONS- The effects of routine blood pressure lowering and intensive glucose control were independent of one another. When combined, they produced additional reductions in clinically relevant outcomes.</div>
</front>
</TEI>
<affiliations><list><country><li>Australie</li>
<li>Canada</li>
<li>France</li>
<li>Pays-Bas</li>
<li>Royaume-Uni</li>
<li>États-Unis</li>
</country>
<region><li>Gueldre</li>
<li>Nouvelle-Galles du Sud</li>
<li>Utrecht (province)</li>
<li>État de New York</li>
<li>Île-de-France</li>
</region>
<settlement><li>Nimègue</li>
<li>Paris</li>
<li>Sydney</li>
<li>Utrecht</li>
</settlement>
<orgName><li>Université de Sydney</li>
</orgName>
</list>
<tree><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Zoungas, Sophia" sort="Zoungas, Sophia" uniqKey="Zoungas S" first="Sophia" last="Zoungas">Sophia Zoungas</name>
</region>
<name sortKey="Chalmers, John" sort="Chalmers, John" uniqKey="Chalmers J" first="John" last="Chalmers">John Chalmers</name>
<name sortKey="De Galan, Bastiaan E" sort="De Galan, Bastiaan E" uniqKey="De Galan B" first="Bastiaan E." last="De Galan">Bastiaan E. De Galan</name>
<name sortKey="Macmahon, Stephen" sort="Macmahon, Stephen" uniqKey="Macmahon S" first="Stephen" last="Macmahon">Stephen Macmahon</name>
<name sortKey="Neal, Bruce" sort="Neal, Bruce" uniqKey="Neal B" first="Bruce" last="Neal">Bruce Neal</name>
<name sortKey="Ninomiya, Toshiharu" sort="Ninomiya, Toshiharu" uniqKey="Ninomiya T" first="Toshiharu" last="Ninomiya">Toshiharu Ninomiya</name>
<name sortKey="Patel, Anushka" sort="Patel, Anushka" uniqKey="Patel A" first="Anushka" last="Patel">Anushka Patel</name>
<name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name>
<name sortKey="Zoungas, Sophia" sort="Zoungas, Sophia" uniqKey="Zoungas S" first="Sophia" last="Zoungas">Sophia Zoungas</name>
</country>
<country name="Pays-Bas"><region name="Gueldre"><name sortKey="De Galan, Bastiaan E" sort="De Galan, Bastiaan E" uniqKey="De Galan B" first="Bastiaan E." last="De Galan">Bastiaan E. De Galan</name>
</region>
<name sortKey="Grobbee, Diederick" sort="Grobbee, Diederick" uniqKey="Grobbee D" first="Diederick" last="Grobbee">Diederick Grobbee</name>
</country>
<country name="Canada"><noRegion><name sortKey="Hamet, Pavel" sort="Hamet, Pavel" uniqKey="Hamet P" first="Pavel" last="Hamet">Pavel Hamet</name>
</noRegion>
</country>
<country name="Royaume-Uni"><noRegion><name sortKey="Heller, Simon" sort="Heller, Simon" uniqKey="Heller S" first="Simon" last="Heller">Simon Heller</name>
</noRegion>
</country>
<country name="France"><region name="Île-de-France"><name sortKey="Marre, Michel" sort="Marre, Michel" uniqKey="Marre M" first="Michel" last="Marre">Michel Marre</name>
</region>
</country>
<country name="États-Unis"><region name="État de New York"><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name>
</region>
</country>
</tree>
</affiliations>
</record>

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Combined Effects of Routine Blood Pressure Lowering and Intensive Glucose Control on Macrovascular and Microvascular Outcomes in Patients With Type 2 Diabetes: New results from the ADVANCE trial

Combined Effects of Routine Blood Pressure Lowering and Intensive Glucose Control on Macrovascular and Microvascular Outcomes in Patients With Type 2 Diabetes: New results from the ADVANCE trial

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