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Efficacy and safety of routine blood pressure lowering in older patients with diabetes: Results from the advance trial

Ninomiya, Toshiharu, Zoungas, Sophia, Neal, Bruce, Woodward, Mark, Patel, Anushka A., Perkovic, Vlado, Cass, Alan, Cooper, Mark, Grobbee, Diederick, Hamet, Pavel, Harrap, Stephen, Liu, Lisheng, Mancia, Giuseppe, Mogensen, Carl-Erick, Poulter, Neil, Rodgers, Anthony, Williams, Bryan, MacMahon, Stephen, Chalmers, John and ADVANCE Collaborative Group (2010). Efficacy and safety of routine blood pressure lowering in older patients with diabetes: Results from the advance trial. Journal of Hypertension,28(6):1141-1149.

Document type: Journal Article

IRMA ID 84473293xPUB48
Title Efficacy and safety of routine blood pressure lowering in older patients with diabetes: Results from the advance trial
Author Ninomiya, Toshiharu
Zoungas, Sophia
Neal, Bruce
Woodward, Mark
Patel, Anushka A.
Perkovic, Vlado
Cass, Alan
Cooper, Mark
Grobbee, Diederick
Hamet, Pavel
Harrap, Stephen
Liu, Lisheng
Mancia, Giuseppe
Mogensen, Carl-Erick
Poulter, Neil
Rodgers, Anthony
Williams, Bryan
MacMahon, Stephen
Chalmers, John
ADVANCE Collaborative Group
Journal Name Journal of Hypertension
Publication Date 2010
Volume Number 28
Issue Number 6
ISSN 0263-6352   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-77952468076
Start Page 1141
End Page 1149
Total Pages 8
Publisher Global Science Press
HERDC Category C1 - Journal Article (DIISR)
The efficacy and safety of blood pressure lowering in elderly patients have not been sufficiently investigated in patients with diabetes. Using data from the Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation study, we assessed the efficacy and safety of routine blood pressure lowering to prevent major clinical outcomes in elderly patients with type 2 diabetes.


Eleven thousand one hundred and forty patients aged at least 55 years with type 2 diabetes (mean 66+/-6 years) were randomly assigned to perindopril-indapamide or placebo. The primary endpoint was a composite of major macrovascular and microvascular disease. The effects of active treatment on outcomes were estimated in subgroups according to age: below 65, 65-74 and at least 75 years.


During a mean 4.3-year follow-up, 1799 (16.1%) patients experienced a major event. Active treatment produced similar relative risk reductions for the primary outcome, major macrovascular disease, death and renal events across age groups (all P heterogeneity >0.3). Over 5 years, active treatment was estimated to prevent one primary outcome in every 21, 71 and 118 patients of at least 75, 65-74 and below 65 years, respectively. Similar patterns of benefits were observed for secondary outcomes. There were no differences in the tolerability between randomized allocations across age groups (all P heterogeneity >0.6)


Routine administration of perindopril-indapamide lowers blood pressure safely and reduces the risk of major clinical outcomes in patients of at least 75 years with type 2 diabetes. The greater absolute benefits in older patients in this age group were not offset by an increased risk of side effects.
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Created: Tue, 24 Feb 2015, 12:26:49 CST