Combination blood pressure lowering therapy in patients with type 2 diabetes: messages from the ADVANCE trial

Figures

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  FIGURE 1. Cumulative incidence of events, according to perindopril-indapamide versus placebo in ADVANCE and ADVANCE-ON. Panels a and b compare the two treatment arms during the randomized trial period, whilst panels c and d compare the study groups during the posttrial follow-up in ADVANCE-ON after an additional 5.4 years of observation. (a) Combined major macrovascular or microvascular outcomes; (b) all-cause mortality; (c) death from cardiovascular cause; (d) death from any cause. Panels a and b obtained with permission from Patel A, MacMahon S, Chalmers J, Neal B, Woodward M, Billot L, et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 370:829–40 [8]. Copyright © (2007) and panels c and d obtained with permission from Zoungas S, Chalmers J, Neal B, Billot L, Li Q, Hirakawa Y, et al. Follow-up of blood pressure lowering and glucose control in type 2 diabetes. N Engl J Med 371:1392−1406 [10]. Copyright © 2014. Massachusetts Medical Society: Reprinted with permission.

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  FIGURE 2. Effects of blood pressure lowering in ADVANCE on the risk of major vascular events and mortality. Effects are according to (a) baseline BP and (b) categories of 10-year risk for ASCVD and baseline SBP levels. White diamonds in B indicate the hazard ratios for those with atherosclerotic cardiovascular disease (ASCVD) risk <20% and for those with ASCVD risk ≥20%. Black diamonds indicate the hazard ratios of overall participants for the current study. Figure obtained with permission from Rahman F, McEvoy JW, Ohkuma T, Marre M, Hamet P, Harrap S, et al. Effects of blood pressure lowering on clinical outcomes according to baseline blood pressure and cardiovascular risk in patients with type 2 diabetes mellitus: the ADVANCE trial. Hypertension 2019;73:1291–99. Copyright © (2019).

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  FIGURE 3. Combined effects of BP lowering and intensive glucose control on the incidence of all-cause mortality. HRs and relative risk reductions (RRR) are given for intensive glucose control compared with standard glucose control in the BP lowering arm and for perindopril-indapamide compared with placebo in the glucose lowering arm. Figure reproduced from Zoungas S, de Galan BE, Ninomiya T, Grobbee D, Hamet P, Heller S, et al. 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. Diabetes Care 2009;32:2068–74 [28], under the terms of the Creative Commons CC BY License. Copyright © (2009).

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  FIGURE 4. Long-term SBP response and risk ratio for achieving BP <140/90 mmHg in at least half of all follow-up visits according to change in SBP during active run-in. (a) Mean difference in SBP between active and placebo during trial follow-up and (b) risk ratio for achieving BP target in at least half of all follow-up visits. Figure obtained with permission from Wang N, Harris K, Woodward M, Harrap S, Mancia G, Poulter N, et al. Clinical utility of short-term blood pressure measures to inform long-term blood pressure management Hypertension 2023;80:608–17 [41]. Copyright © (2023).