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Australian-led international study shows blood pressure drugs cut death rate in type 2 diabetes

The largest-ever study of treatments for type 2 diabetes has shown that a combination of two blood pressure lowering drugs reduced the risk of death, as well as the risks of heart and kidney disease. The ADVANCE (Action in Diabetes and Vascular Disease) Study was led by researchers at The George Institute for International Health in Sydney and the results have been presented at the European Congress of Cardiology in Vienna.

One of the study leaders, Professor Stephen MacMahon, Principal Director of The George Institute, said "These results represent an important step forward in the care of people with type 2 diabetes worldwide. This treatment reduced the likelihood of dying from the complications of diabetes by almost one-fifth, and could potentially save several millions of lives over the next decade if the treatment was widely implemented.”

More than 600,000 Australians and more than 250 million people worldwide have type 2 diabetes, and most will eventually die or be disabled by the complications. The most common cause of death is heart disease, but kidney disease also affects a large proportion. In 2006, the United Nations called for increased international action to combat the global epidemic of diabetes.

More than 11,000 patients with type 2 diabetes in 20 countries world wide participated in the 4.3 year project. Half received daily treatment with a single tablet containing a fixed combination of two blood pressure lowering drugs (perindopril plus indapamide) and half received matching inactive placebo.

“Importantly, the ADVANCE results showed that patients with type 2 diabetes benefited from this blood pressure lowering treatment irrespective of whether or not their blood pressure was elevated to begin with,” said study investigator, Dr Bruce Neal, of The George Institute,

“The participants in ADVANCE were already receiving most of the usual treatments provided to patients with diabetes, including other drugs to lower blood pressure,” explained Dr. Anushka Patel, of The George Institute and the ADVANCE Study Director. “However, the addition of the fixed combination of perindopril and indapamide reduced the risk of death from any cause by 14% and the risk of death from cardiovascular disease by 18%. Over 5 years, this treatment would prevent one death among every 80 patients treated.”

“The results clearly demonstrate that we have the tools to blunt the impact of the global diabetes epidemic facing rich and poor countries alike. But concerted action is urgently required to ensure that patients with diabetes are identified and provided with treatments proven to improve important outcomes like survival,” added Professor John Chalmers, the author of international guidelines for the treatment of high blood pressure and chairman of the study management group.

Janet Hall | EurekAlert!
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