Lowering Blood Pressure Reduces Renal Events in Type 2 Diabetes
Key result
Fixed combination perindopril-indapamide reduced the risk of major renal events by 21% (HR 0.79) compared to placebo in patients with type 2 diabetes, regardless of initial blood pressure.
Why the study?
Does fixed combination perindopril-indapamide reduce renal events in patients with type 2 diabetes?
Population
11,140 patients with type 2 diabetes participating in the ADVANCE study
Comparison
Fixed combination perindopril-indapamide… vs Placebo
Design
RCT, Randomly assigned
Follow-up
mean 4.3 years
Authors
Discussion
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Member takes
Implication
Supports perindopril-indapamide for renoprotection in type 2 diabetes even below 130/80 mmHg; challenges consensus on BP treatment thresholds.
Study Design
Type
RCT (n=11,140)
Blinding
Double-blind
Randomization
randomly assigned
Multicenter
Yes
Structured PICO
Does fixed combination perindopril-indapamide reduce renal events in patients with type 2 diabetes?
P
Population
11,140 patients with type 2 diabetes participating in the ADVANCE study
I
Intervention
Fixed combination perindopril-indapamide administered routinely regardless of baseline blood pressure
C
Comparator
Placebo
O
Outcome
Renal eventscomposite
Main Result
Effect estimate: HR 0.79 (95% CI 0.73 to 0.85)
Absolute Event Rate: 22.3% vs 26.9%
p-value: p=<0.0001
Routine blood pressure lowering with perindopril-indapamide provides significant renoprotection in patients with type 2 diabetes, even among those with initial blood pressure below currently recommended thresholds (<120/70 mmHg).
Limitations
- The study was not designed to determine the separate effects of the individual components (perindopril and indapamide).
- No data were collected on intake or excretion of sodium.
Cite This Study
Galan et al. (2009) conducted an RCT in Type 2 diabetes (n=11,140). perindopril-indapamide vs. placebo was evaluated on Composite of new-onset microalbuminuria, new-onset nephropathy, doubling of serum creatinine to ≥200 μmol/L, or end-stage kidney disease (HR 0.79, 95% CI 0.73 to 0.85, p=<0.0001). Fixed combination perindopril-indapamide reduced the risk of major renal events by 21% (HR 0.79) compared to placebo in patients with type 2 diabetes, regardless of initial blood pressure.