02892nas a2200373   4500000000100000008004100001100001500042700001600057700001400073700001500087700002200102700001500124700001800139700001900157700001500176700001400191700001300205700001600218700001400234700001300248700001400261700001400275700001600289700001900305700001500324700001800339700001500357245019900372250001500571300001200586490000700598520186700605020004602472       2009                            d1 aGrobbee D.1 aNinomiya T.1 aCass Alan1 aTravert F.1 ade Galan Bastiaan1 aLisheng L.1 aWoodward Mark1 aZoungas Sophia1 aPoulter N.1 aPillai A.1 aMarre M.1 aGlasziou P.1 aHarrap S.1 aHamet P.1 aMancia G.1 aHeller S.1 aChalmers J.1 aPerkovic Vlado1 aNeal Bruce1 aPatel Anushka1 aMacmahon S00aCombined effects of routine blood pressure lowering and intensive glucose control on macrovascular and microvascular outcomes in patients with type 2 diabetes: New results from the ADVANCE trial  a2009/08/05  a2068-740 v323 a<p>
OBJECTIVE: To assess the magnitude and independence of the effects of routine blood pressure lowering and intensive glucose control on clinical outcomes in patients with long-standing type 2 diabetes. RESEARCH DESIGN AND METHODS: This was a multicenter, factorial randomized trial of perindopril-indapamide versus placebo (double-blind comparison) and intensive glucose control with a gliclazide MR-based regimen (target A1C <or=6.5%) 140="" 2="" 4.3="" action="" all="" an="" and="" annual="" any="" average="" between="" blood="" clinical="" considered="" control="" controlled="" cox="" death="" diabetes="" diamicron="" disease:="" during="" effects="" evaluation="" event="" events="" follow-up="" for="" glucose="" hazards="" in="" intensive="" interaction="" jointly="" lowering="" macrovascular="" major="" microvascular="" models.="" mr="" no="" of="" open="" outcomes="" p="" participants="" participated="" prespecified="" pressure="" preterax="" proportional="" rates="" renal="" results:="" risks="" routine="" standard="" the="" there="" trial.="" type="" using="" vascular="" versus="" was="" were="" who="" with="" years=""> 0.1): the separate effects of the two interventions for the renal outcomes and death appeared to be additive on the log scale. Compared with neither intervention, combination treatment reduced the risk of new or worsening nephropathy by 33% (95% CI 12-50%, P = 0.005), new onset of macroalbuminuria by 54% (35-68%, P &lt; 0.0001), and new onset of microalbuminuria by 26% (17-34%). Combination treatment was associated with an 18% reduction in the risk of all-cause death (1-32%, P = 0.04). CONCLUSIONS: The effects of routine blood pressure lowering and intensive glucose control were independent of one another. When combined, they produced additional reductions in clinically relevant outcomes.</or=6.5%)>
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