New ADVANCEs in guidelines

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Abstract

Background

Recently published Guidelines for the Management of Arterial Hypertension jointly written by the European Society of Hypertension and the European Society of Cardiology are of great relevance to the diabetic population as a result of the elevated cardiovascular and renal risk that accompanies the simultaneous presence of hypertension and diabetes. Guidelines also recognize the relevance of prediabetes, a situation characterized by the presence of the metabolic syndrome.

Methods

Guidelines consider the need for integral protection of the cardiovascular and renal systems that includes a goal blood pressure (BP) lower than 130/80 mmHg, accompanied by strict metabolic and lipid control often accompanied by antiplatelet therapy. In order to attain the adequate BP and cardiorenal protection beyond the BP decrease, suppression of the renin–angiotensin system should be attempted, usually in association with other antihypertensive drugs.

Results

A few months after the publication of the guidelines, the ADVANCE study was published. This study has shown that the addition of a fixed combination of perindopril and indapamide on top of the other medications in patients with diabetes with BP ranging from normal to elevated greatly helps diminish BP when required, while protecting the cardiovascular and renal systems from the deleterious effects of diabetes associated with high BP. This protection includes as the most relevant finding a significant decrease in all-cause death.

Conclusion

The combination of a diminution in BP with further suppression of the renin–angiotensin system obtained through the administration of a fixed combination of perindopril and indapamide explains the benefits observed in ADVANCE in terms of the cardiovascular and renal prognosis of patients with diabetes with BP ranging from normal to elevated.

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