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Effects of a fixed combination of perindopril and indapamide in patients with type 2 diabetes and chronic kidney disease

Lambers Heerspink, Hiddo J., Ninomiya, Toshiharu, Perkovic, Vlado, Woodward, Mark, Zoungas, Sophia, Cass, Alan, Cooper, Mark, Grobbee, Diederick, Mancia, Giuseppe, Mogensen, Carl Erick, Neal, Broce and Chalmers, John (2010). Effects of a fixed combination of perindopril and indapamide in patients with type 2 diabetes and chronic kidney disease. European Heart Journal,31(23):2888-2896.

Document type: Journal Article

IRMA ID 84473293xPUB44
Title Effects of a fixed combination of perindopril and indapamide in patients with type 2 diabetes and chronic kidney disease
Author Lambers Heerspink, Hiddo J.
Ninomiya, Toshiharu
Perkovic, Vlado
Woodward, Mark
Zoungas, Sophia
Cass, Alan
Cooper, Mark
Grobbee, Diederick
Mancia, Giuseppe
Mogensen, Carl Erick
Neal, Broce
Chalmers, John
Journal Name European Heart Journal
Publication Date 2010
Volume Number 31
Issue Number 23
ISSN 0195-668X   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-78649875453
Start Page 2888
End Page 2896
Total Pages 8
Publisher Oxford University Press
HERDC Category C1 - Journal Article (DIISR)
Abstract Aims
Individuals 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 results

Patients 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.

Conclusion
The 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.

Keywords ACE-inhibitor
type 2 diabetes
chronic kidney disease
DOI http://dx.doi.org/10.1093/eurheartj/ehq139   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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