Intensive BP lowering for people with diabetes – beneficial effects delivered

There remains some debate about what the optimal blood pressure (BP) goal should be for patients with diabetes mellitus. In a brand new study, the ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation) 10, 948 people with diabetes had 4.3 years of follow-up during treatment with perindopril-indapamide versus placebo to ascertain if reduced mortality and major vascular (macrovascular or microvascular) events could be demonstrated. There was no evidence of differences in these effects, regardless of baseline systolic BP (evaluated down to <120 mm Hg; P for heterogeneity, 0.85), diastolic BP (evaluated down to <70 mm Hg; P=0.49), or whether 10-year CVD risk was ≥20% or <20% (P=0.08). Randomized treatment on discontinuation of treatment because of cough or hypotension/dizziness produced statistically consistent effects across subgroups defined by baseline BP and CVD risk (all P ≥ 0.08). The researchers conclude that adults with diabetes mellitus appear to benefit from more intensive BP treatment even at levels of BP and CVD risk that some guidelines do not currently recommend for intervention.