Protection of patients with diabetes, with or without hypertension: Implications of ADVANCE for clinical practice

Giuseppe Mancia, Guido Grassi

Research output: Contribution to journalArticlepeer-review


Difficulties in achieving a reduction in morbidity and mortality in patients with diabetes are a result of the complexity of the disease and its intertwined relationship with hypertension and renal impairment. In the recently published Action in Diabetes and Vascular disease: PreterAx and DiamicroN-MR Controlled Evaluation (ADVANCE) trial, treatment of patients with diabetes with the fixed combination perindopril/indapamide on top of background treatments provided clinically and statistically significant reductions in blood pressure (from 145/81 to 136/73 mmHg), all-cause mortality (S14%), cardiovascular mortality (S18%), major cardiovascular events (S9%), renal events (S21%) and new-onset microalbuminuria (S21%) when compared with placebo. As the ADVANCE trial included both hypertensive and normotensive patients, its results suggest that systematically treating all patients with diabetes with perindopril/indapamide, independently of their baseline blood pressure, may have significant longterm value that can be explained partly by the reversal of end-organ damage to the kidney and the heart. Considering that patients with both hypertension and diabetes are characterized by generalized macro-and microvascular disease, the results of the ADVANCE trial, taken together with results of other perindopril/indapamide hypertension studies, support a broad use of perindopril/indapamide treatment for the long-term improvement of prognosis in hypertensive patients as well as in patients with diabetes.

Original languageEnglish
JournalJournal of Hypertension
Issue numberSUPPL. 1
Publication statusPublished - 2009


  • Cardiovascular protection
  • Combination therapy
  • Hypertension
  • Indapamide
  • Perindopril
  • Type 2 diabetes

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine
  • Internal Medicine


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