TY - JOUR
T1 - Effects of a fixed combination of perindopril and indapamide in patients with type 2 diabetes and chronic kidney disease
AU - Lambers Heerspink, Hiddo J.
AU - Ninomiya, Toshiharu
AU - Perkovic, Vlado
AU - Woodward, Mark
AU - Zoungas, Sophia
AU - Cass, Alan
AU - Cooper, Mark
AU - Grobbee, Diederick E.
AU - Mancia, Giuseppe
AU - Mogensen, Carl Eric
AU - Neal, Bruce
AU - Chalmers, John
N1 - Funding Information:
The ADVANCE trial was supported by grants from Servier and the National Health and Medical Research Council Australia (211086 and 358395).
Funding Information:
All members of the ADVANCE collaborative study group have been listed in full in the appendix provided as Supplementary material online. We thank the patients and all of the investigators at the participating centres. H.J. Lambers Heerspink was supported by a Fellowship from the Dutch Kidney Foundation and International Society of Hypertension Visiting Postdoctoral Fellowship awarded by the Foundation for High Blood Pressure Research Council of Australia.
PY - 2010/12
Y1 - 2010/12
N2 - AimsIndividuals with diabetes and chronic kidney disease (CKD) are at high risk for cardiovascular disease. In these analyses of the ADVANCE trial, we assessed the effects of a fixed combination of perindopril-indapamide on renal and cardiovascular outcomes in patients with type 2 diabetes according to baseline CKD stage. Methods and resultsPatients with type 2 diabetes were randomized to perindopril-indapamide (4 mg/1.25 mg) or placebo. Treatment effects on cardiovascular (cardiovascular death, myocardial infarction, or stroke) and renal outcomes were compared in subgroups defined by baseline Kidney Disease Outcome Quality Initiative CKD stage. Homogeneity in treatment effect was tested by adding interaction terms to the relevant Cox models. The study included 10 640 participants with known CKD status, of whom 6125 did not have CKD, 2482 were classified as CKD stage 1 or 2, and 2033 as CKD stage ≥3. The relative treatment effects on major cardiovascular events were similar across all stages of CKD, with no heterogeneity in the magnitude of the effects for any outcome. In contrast, the absolute treatment effects approximately doubled in those with CKD stage ≥3 when compared to those with no CKD. For every 1000 patients with CKD stage ≥3 treated for 5 years, active treatment prevented 12 cardiovascular events when compared with six events per 1000 patients with no CKD. ConclusionThe treatment benefits of a routine administration of a fixed combination of perindopril-indapamide to patients with type 2 diabetes on cardiovascular and renal outcomes, and death, are consistent across all stages of CKD at baseline. Absolute risk reductions are larger in patients with CKD highlighting the importance of blood pressure-lowering in this population.
AB - AimsIndividuals with diabetes and chronic kidney disease (CKD) are at high risk for cardiovascular disease. In these analyses of the ADVANCE trial, we assessed the effects of a fixed combination of perindopril-indapamide on renal and cardiovascular outcomes in patients with type 2 diabetes according to baseline CKD stage. Methods and resultsPatients with type 2 diabetes were randomized to perindopril-indapamide (4 mg/1.25 mg) or placebo. Treatment effects on cardiovascular (cardiovascular death, myocardial infarction, or stroke) and renal outcomes were compared in subgroups defined by baseline Kidney Disease Outcome Quality Initiative CKD stage. Homogeneity in treatment effect was tested by adding interaction terms to the relevant Cox models. The study included 10 640 participants with known CKD status, of whom 6125 did not have CKD, 2482 were classified as CKD stage 1 or 2, and 2033 as CKD stage ≥3. The relative treatment effects on major cardiovascular events were similar across all stages of CKD, with no heterogeneity in the magnitude of the effects for any outcome. In contrast, the absolute treatment effects approximately doubled in those with CKD stage ≥3 when compared to those with no CKD. For every 1000 patients with CKD stage ≥3 treated for 5 years, active treatment prevented 12 cardiovascular events when compared with six events per 1000 patients with no CKD. ConclusionThe treatment benefits of a routine administration of a fixed combination of perindopril-indapamide to patients with type 2 diabetes on cardiovascular and renal outcomes, and death, are consistent across all stages of CKD at baseline. Absolute risk reductions are larger in patients with CKD highlighting the importance of blood pressure-lowering in this population.
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U2 - 10.1093/eurheartj/ehq139
DO - 10.1093/eurheartj/ehq139
M3 - Article
C2 - 20501479
AN - SCOPUS:78649875453
SN - 0195-668X
VL - 31
SP - 2888
EP - 2896
JO - European heart journal
JF - European heart journal
IS - 23
ER -
