Intensive blood pressure treatment isn’t just for high-risk patients with diabetes, based on a clinical trial testing the risks and benefits of two antihypertensive drugs, preterex and diamicron. Findings were recently published in the American Heart Association journal Hypertension, and suggest all diabetics at risk for heart disease benefit from treatment, regardless of risk.
Known as the ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation), this study looked at the impact of aggressive blood pressure treatment in patients with diabetes. The trial itself studied whether the combination therapy improved outcomes when compared to an inactive placebo pill—which it did. However, the recent analysis took a deeper look at findings to see if the benefits vary by cardiovascular risk.
In total, the analysis included 10,948 patients with diabetes at moderate to high risk for heart events. By study definition, that means participants either had heart disease already or had at least two major risk factors for developing it.
After being randomized to the study treatment, participants were followed for four years for the development of heart disease, heart events and death.
As the overall study showed, the combination blood pressure therapy significantly reduced risk for both heart events and death when compared to placebo. However, the additional analysis showed that benefits were the same, regardless of a patient’s health at start of the study.
For example, researchers found that the hypertensive therapy worked the same in patients with normal blood pressure vs. very high blood pressure. Intensive therapy also improved outcomes equally in patients who had a low vs. high risk of experiencing a heart event in the next ten years.
What that means, according to authors, is that blood pressure therapy should not be reserved for high-risk patients with diabetes. In this study, intensive blood pressure medication improved outcomes in all patients with diabetes.
Since diabetes significantly increases risk for heart events, increasing the use of blood pressure treatment in diabetic patients could save countless lives. According to the Centers for Disease Control and Prevention, more than 30 million Americans have diabetes. People with diabetes are twice as likely to have a stroke or heart attack as those without diabetes, making it the 7th leading cause of death in the United States.
Of course, there are a few things to keep in mind about study findings.
As authors note, the trial included patients with diabetes who either had heart disease or had two cardiovascular risk factors, such as obesity or high cholesterol. It also included only patients with type 2 diabetes, which occurs when the body doesn’t use insulin or blood sugar properly. Type 2 diabetes is the most common form of diabetes and accounts for up to 95% of all diabetes cases.
For these reasons, findings can’t be applied to different populations—such as very low risk patients or those with type 1 diabetes. However, findings remain promising for patients with type 2 diabetes who face increased risk for heart disease.
Authors add that since the optimal blood pressure goal in patients with diabetes remains controversial, they hope recent findings help shed light on which patients might benefit from intensive blood pressure treatment. Experts also encourage further research on the issue, as improved treatment could improve survival and quality of life for millions with diabetes.