Can lowering blood pressure prevent vascular complications in patients with type 2 diabetes?
Jan A Staessen
Correspondence Study Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven–Gasthuisberg Campus, Box 702, Herestraat 49, B-3000 Leuven, Belgium
Email jan.staessen@med.kuleuven.be
This article has no abstract so we have provided the first paragraph of the full text.
Modern guidelines for the treatment of hypertension emphasize the global cardiovascular risk of the individual and recommend risk stratification based on BP, target-organ damage, and associated conditions, such as diabetes mellitus.1 Hypertension, hypercholesterolemia, and cigarette smoking account for approximately 85% of the modifiable cardiovascular risk worldwide.2 In patients at high-risk of CVD, substantially reducing normal or slightly-elevated cholesterol levels enhances the risk reduction afforded by antihypertensive treatment.2 The ADVANCE trial answers the analogous question of whether reducing a normal or only moderately elevated BP might also improve outcomes in high-risk patients. In this study, treatment with indapamide plus perindopril led to an 18% decrease in cardiovascular mortality and a 9% reduction in the incidence of microvascular and macrovascular complications when compared with placebo, in unselected patients with diabetes. These findings support the concepts of global cardiovascular risk and multiple risk-factor intervention.1
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