Management of high blood pressure in type 2 diabetes: perindopril/indapamide fixed-dose combination and the ADVANCE trial

IMPORTANCE OF THE FIELD: The increase in type 2 diabetes mellitus is associated to cardiovascular morbidity and mortality. This review focuses on the benefits of the fixed-dose combination of perindopril and indapamide on cardiovascular and renal end points in the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation) trial. AREAS COVERED IN THE REVIEW: In the last decade, clinical trials have indicated that blood pressure reduction and glucose lowering were effective in reducing morbidity and morbility. The ADVANCE trial has explored both intensive glucose lowering with gliclazide modified release (MR) and intensive blood pressure lowering using a fixed combination of perindopril/indapamide, on top of current treatments, including renin-angiotensin inhibitors. WHAT THE READER WILL GAIN: In ADVANCE, perindopril/indapamide reduced a composite of macrovascular and microvascular events, also significantly decreasing cardiovascular mortality and death from any cause and reducing coronary and renal complications. The review discusses the relevance of results and the advantages of this therapeutic strategy in clinical practice. TAKE HOME MESSAGE: ADVANCE provides a new, simple and pragmatic treatment algorithm that maximizes clinical benefits and is suitable for all type 2 diabetic patients: intensive blood pressure lowering based on combined perindopril/indapamide with intensive glucose lowering based on gliclazide MR.