Combined Effects of Routine Blood Pressure Lowering and Intensive Glucose Control on Macrovascular and Microvascular Outcomes in Patients With Type 2 Diabetes
Identifieur interne : 008318 ( Main/Merge ); précédent : 008317; suivant : 008319Combined Effects of Routine Blood Pressure Lowering and Intensive Glucose Control on Macrovascular and Microvascular Outcomes in Patients With Type 2 Diabetes
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] ; John Chalmers [Australie]Source :
- Diabetes Care [ 0149-5992 ] ; 2009.
Abstract
To assess the magnitude and independence of the effects of routine blood pressure lowering and intensive glucose control on clinical outcomes in patients with long-standing type 2 diabetes.
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.
There was no interaction between the effects of routine blood pressure lowering and intensive glucose control for any of the prespecified clinical outcomes (all
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:
DOI: 10.2337/dc09-0959
PubMed: 19651921
PubMed Central: 2768202
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wicri:level="4"><nlm:aff id="aff1">The George Institute for International Health, University of Sydney, Sydney, New South Wales, Australia;</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>The George Institute for International Health, University of Sydney, Sydney, New South Wales</wicri:regionArea><orgName type="university">Université de Sydney</orgName><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2">Monash University, Melbourne, Victoria, Australia;</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Monash University, Melbourne, Victoria</wicri:regionArea><wicri:noRegion>Victoria</wicri:noRegion></affiliation></author><author><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><affiliation wicri:level="4"><nlm:aff id="aff1">The George Institute for International Health, University of Sydney, Sydney, New South Wales, Australia;</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>The George Institute for International Health, University of Sydney, Sydney, New South Wales</wicri:regionArea><orgName type="university">Université de Sydney</orgName><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff3">Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands;</nlm:aff><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen</wicri:regionArea><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation></author><author><name sortKey="Ninomiya, Toshiharu" sort="Ninomiya, Toshiharu" uniqKey="Ninomiya T" first="Toshiharu" last="Ninomiya">Toshiharu Ninomiya</name><affiliation wicri:level="4"><nlm:aff id="aff1">The George Institute for International Health, University of Sydney, Sydney, New South Wales, Australia;</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>The George Institute for International Health, University of Sydney, Sydney, New South Wales</wicri:regionArea><orgName type="university">Université de Sydney</orgName><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Grobbee, Diederick" sort="Grobbee, Diederick" uniqKey="Grobbee D" first="Diederick" last="Grobbee">Diederick Grobbee</name><affiliation wicri:level="3"><nlm:aff id="aff4">Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands;</nlm:aff><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht</wicri:regionArea><placeName><settlement type="city">Utrecht</settlement><region nuts="2" type="province">Utrecht (province)</region></placeName></affiliation></author><author><name sortKey="Hamet, Pavel" sort="Hamet, Pavel" uniqKey="Hamet P" first="Pavel" last="Hamet">Pavel Hamet</name><affiliation wicri:level="1"><nlm:aff id="aff5">Centre Hospitalier de l'Université de Montreal and Université de Montreal, Montreal, Quebec, Canada;</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Centre Hospitalier de l'Université de Montreal and Université de Montreal, Montreal, Quebec</wicri:regionArea><wicri:noRegion>Quebec</wicri:noRegion></affiliation></author><author><name sortKey="Heller, Simon" sort="Heller, Simon" uniqKey="Heller S" first="Simon" last="Heller">Simon Heller</name><affiliation wicri:level="1"><nlm:aff id="aff6">University of Sheffield and Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield, U.K.;</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>University of Sheffield and Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield</wicri:regionArea><wicri:noRegion>Sheffield</wicri:noRegion></affiliation></author><author><name sortKey="Macmahon, Stephen" sort="Macmahon, Stephen" uniqKey="Macmahon S" first="Stephen" last="Macmahon">Stephen Macmahon</name><affiliation wicri:level="4"><nlm:aff id="aff1">The George Institute for International Health, University of Sydney, Sydney, New South Wales, Australia;</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>The George Institute for International Health, University of Sydney, Sydney, New South Wales</wicri:regionArea><orgName type="university">Université de Sydney</orgName><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Marre, Michel" sort="Marre, Michel" uniqKey="Marre M" first="Michel" last="Marre">Michel Marre</name><affiliation wicri:level="3"><nlm:aff id="aff7">Hôpital Bichat-Claude Bernard and Université Paris 7, Paris, France;</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Hôpital Bichat-Claude Bernard and Université Paris 7, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Neal, Bruce" sort="Neal, Bruce" uniqKey="Neal B" first="Bruce" last="Neal">Bruce Neal</name><affiliation wicri:level="4"><nlm:aff id="aff1">The George Institute for International Health, University of Sydney, Sydney, New South Wales, Australia;</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>The George Institute for International Health, University of Sydney, Sydney, New South Wales</wicri:regionArea><orgName type="university">Université de Sydney</orgName><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Patel, Anushka" sort="Patel, Anushka" uniqKey="Patel A" first="Anushka" last="Patel">Anushka Patel</name><affiliation wicri:level="4"><nlm:aff id="aff1">The George Institute for International Health, University of Sydney, Sydney, New South Wales, Australia;</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>The George Institute for International Health, University of Sydney, Sydney, New South Wales</wicri:regionArea><orgName type="university">Université de Sydney</orgName><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name><affiliation wicri:level="4"><nlm:aff id="aff1">The George Institute for International Health, University of Sydney, Sydney, New South Wales, Australia;</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>The George Institute for International Health, University of Sydney, Sydney, New South Wales</wicri:regionArea><orgName type="university">Université de Sydney</orgName><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation><affiliation><nlm:aff id="aff8">Mount Sinai School of Medicine, New York, New York.</nlm:aff><wicri:noCountry code="subfield">New York.</wicri:noCountry></affiliation></author><author><name sortKey="Chalmers, John" sort="Chalmers, John" uniqKey="Chalmers J" first="John" last="Chalmers">John Chalmers</name><affiliation wicri:level="4"><nlm:aff id="aff1">The George Institute for International Health, University of Sydney, Sydney, New South Wales, Australia;</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>The George Institute for International Health, University of Sydney, Sydney, New South Wales</wicri:regionArea><orgName type="university">Université de Sydney</orgName><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author></analytic><series><title level="j">Diabetes Care</title><idno type="ISSN">0149-5992</idno><idno type="eISSN">1935-5548</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>OBJECTIVE</title><p>To assess the magnitude and independence of the effects of routine blood pressure lowering and intensive glucose control on clinical outcomes in patients with long-standing type 2 diabetes.</p></sec><sec><title>RESEARCH DESIGN AND METHODS</title><p>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.</p></sec><sec><title>RESULTS</title><p>There was no interaction between the effects of routine blood pressure lowering and intensive glucose control for any of the prespecified clinical outcomes (all <italic>P</italic> > 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%, <italic>P</italic> = 0.005), new onset of macroalbuminuria by 54% (35–68%, <italic>P</italic> < 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%, <italic>P</italic> = 0.04).</p></sec><sec><title>CONCLUSIONS</title><p>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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Patel, A" uniqKey="Patel A">A Patel</name></author><author><name sortKey="Macmahon, S" uniqKey="Macmahon S">S MacMahon</name></author><author><name sortKey="Chalmers, J" uniqKey="Chalmers J">J Chalmers</name></author><author><name sortKey="Macmahon, S" uniqKey="Macmahon S">S MacMahon</name></author><author><name sortKey="Chalmers, J" uniqKey="Chalmers J">J Chalmers</name></author><author><name sortKey="Neal, B" uniqKey="Neal B">B Neal</name></author><author><name sortKey="Woodward, M" uniqKey="Woodward M">M Woodward</name></author><author><name sortKey="Billot, L" uniqKey="Billot L">L Billot</name></author><author><name sortKey="Harrap, S" uniqKey="Harrap S">S Harrap</name></author><author><name sortKey="Poulter, N" 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S" uniqKey="Shahinfar S">S Shahinfar</name></author><author><name sortKey="Snapinn, S" uniqKey="Snapinn S">S Snapinn</name></author><author><name sortKey="Cooper, Me" uniqKey="Cooper M">ME Cooper</name></author><author><name sortKey="Mitch, We" uniqKey="Mitch W">WE Mitch</name></author><author><name sortKey="Brenner, Bm" uniqKey="Brenner B">BM Brenner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Holman, Rr" uniqKey="Holman R">RR Holman</name></author><author><name sortKey="Paul, Sk" uniqKey="Paul S">SK Paul</name></author><author><name sortKey="Bethel, Ma" uniqKey="Bethel M">MA Bethel</name></author><author><name sortKey="Matthews, Dr" uniqKey="Matthews D">DR Matthews</name></author><author><name sortKey="Neil, Ha" uniqKey="Neil H">HA Neil</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Piantadosi, S" uniqKey="Piantadosi S">S Piantadosi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stamler, J" uniqKey="Stamler J">J Stamler</name></author><author><name sortKey="Vaccaro, O" uniqKey="Vaccaro O">O Vaccaro</name></author><author><name sortKey="Neaton, Jd" uniqKey="Neaton J">JD Neaton</name></author><author><name sortKey="Wentworth, D" uniqKey="Wentworth D">D Wentworth</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hanefeld, M" uniqKey="Hanefeld M">M Hanefeld</name></author><author><name sortKey="Fischer, S" uniqKey="Fischer S">S Fischer</name></author><author><name sortKey="Julius, U" uniqKey="Julius U">U Julius</name></author><author><name sortKey="Schulze, J" uniqKey="Schulze J">J Schulze</name></author><author><name sortKey="Schwanebeck, U" uniqKey="Schwanebeck U">U Schwanebeck</name></author><author><name sortKey="Schmechel, H" uniqKey="Schmechel H">H Schmechel</name></author><author><name sortKey="Ziegelasch, Hj" uniqKey="Ziegelasch H">HJ Ziegelasch</name></author><author><name sortKey="Lindner, J" uniqKey="Lindner J">J Lindner</name></author></analytic></biblStruct></listBibl></div1></back></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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