Effects of blood pressure lowering on cardiovascular outcomes in different cardiovascular risk groups among participants with type 2 diabetes

AbstractAimsTo asses differences in treatment effects of a fixed combination of perindopril–indapamide on major clinical outcomes in patients with type 2 diabetes across subgroups of cardiovascular risk.Methods11,140 participants with type 2 diabetes, from the ADVANCE trial, were randomized to perindopril–indapamide or matching placebo. The Framingham equation was used to calculate 5-year CVD risk and to divide participants into two risk groups, moderate–high risk (<25% and no history of macrovascular disease), very high risk (>25% and/or history of macrovascular disease). Endpoints were macrovascular and microvascular events.ResultsThe mean age of participants was 66 years (42.5% female). 1000 macrovascular and 916 microvascular events were recorded over follow-up of 4.3 years. Relative treatment effects were similar across risk groups, (all P-values for heterogeneity ≥0.38). Hazard ratios for combined macro- and microvascular events were 0.89 (0.77–1.03) for the moderate-high risk and 0.92 (0.81–1.03) for the very high risk. Absolute treatment effects tended to be greater in the high risk groups although differences were not statistically significant (P>0.05).ConclusionsRelative effects of blood pressure lowering with perindopril–indapamide on cardiovascular outcomes were similar across risk groups whilst absolute effects trended to be greater in the high risk group