The findings from ADVANCE-ON are important. Clinicians need clear evidence that controlling a patient’s blood pressure produces long-term benefits, and the results from ADVANCE-ON provide this. We need many more studies that track the long-term impact of blood pressure reduction. Currently, a large fraction of patients with diabetes are not maintained at the recommended blood pressure levels. This report presents the longest follow-up of any antihypertensive intervention in patients with diabetes.
The findings also show that a small blood pressure reduction can have an important and long-lasting effect. This highlights the value of blood pressure control, even when the reduction achieved in an individual patient seems small.
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I believe that the effects linked with blood pressure reduction in ADVANCE-ON are likely generalizable to any antihypertensive regimen that produces a similar magnitude of effect. It is the blood pressure effect rather than the specific antihypertensive drugs used that is that critical, although drugs that affect the renin-angiotensin-aldosterone system are clearly the first choice for patients with diabetes and hypertension.
Dr. Lars Rydén is a cardiologist at the Karolinska Institute in Stockholm. He has been an adviser to AstraZeneca, Roche, Bristol-Myers Squibb, and Sanofi, and received research grants from Roche. He made these comments as designated discussant for the ADVANCE-ON report and in an interview.
AT THE ESC CONGRESS 2014
