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.
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.
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DOI：
10.2337/dc09-0959
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发表时间：
2009-11
期刊：
影响因子：
16.2
通讯作者：
Travert F
中科院分区：
文献类型：
--
作者：
Zoungas S;de Galan BE;Ninomiya T;Grobbee D;Hamet P;Heller S;MacMahon S;Marre M;Neal B;Patel A;Woodward M;Chalmers J;ADVANCE Collaborative Group;Cass A;Glasziou P;Harrap S;Lisheng L;Mancia G;Pillai A;Poulter N;Perkovic V;Travert F
评估常规降压和强化血糖控制对长期2型糖尿病患者临床结局影响的程度和独立性。这是一项多中心、因子随机试验，在11,140名参加糖尿病和血管疾病的行动：Preterax和Diamicron MR对照评估（ADVANCE）试验的2型糖尿病患者中进行了培哚普利-吲达帕胺与安慰剂（双盲比较）和格列齐特MR为基础的强化血糖控制方案（目标A1C≤6.5%）与标准血糖控制（开放比较）。在平均4.3年的随访期间，使用Cox比例风险模型评估联合和单独考虑的主要大血管和微血管事件、肾脏事件和死亡的年发生率和风险。常规降压和强化血糖控制对任何预先指定的临床结果的影响之间没有相互作用（所有P >.1）：两种干预措施对肾脏结果和死亡的单独影响在对数标度上似乎是相加的。与不采取任何干预措施相比，联合治疗可使肾病新发或恶化的风险降低33% (95% CI 12-50%, P = 0.005)，新发大量蛋白尿风险降低54% (35-68%,P < 0.0001)，新发微量蛋白尿风险降低26%（17-34%）。联合治疗与全因死亡风险降低18%相关（1-32%,P = 0.04）。常规降压和强化血糖控制的效果是相互独立的。当联合使用时，它们产生了临床相关结果的额外降低。
To assess the magnitude and independence of the effects of routine blood pressure lowering and intensive glucose control on clinical outcomes in patients with long-standing type 2 diabetes. This was a multicenter, factorial randomized trial of perindopril-indapamide versus placebo (double-blind comparison) and intensive glucose control with a gliclazide MR–based regimen (target A1C ≤6.5%) versus standard glucose control (open comparison) in 11,140 participants with type 2 diabetes who participated in the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial. Annual event rates and risks of major macrovascular and microvascular events considered jointly and separately, renal events, and death during an average 4.3 years of follow-up were assessed, using Cox proportional hazards models. There was no interaction between the effects of routine blood pressure lowering and intensive glucose control for any of the prespecified clinical outcomes (all P > 0.1): the separate effects of the two interventions for the renal outcomes and death appeared to be additive on the log scale. Compared with neither intervention, combination treatment reduced the risk of new or worsening nephropathy by 33% (95% CI 12–50%, P = 0.005), new onset of macroalbuminuria by 54% (35–68%, P < 0.0001), and new onset of microalbuminuria by 26% (17–34%). Combination treatment was associated with an 18% reduction in the risk of all-cause death (1–32%, P = 0.04). The effects of routine blood pressure lowering and intensive glucose control were independent of one another. When combined, they produced additional reductions in clinically relevant outcomes.