Using a combination of diuretics and ACE inhibitors (two commonly prescribed types of medication) to manage blood pressure in people with type 2 diabetes can help protect against heart disease, according to new data.

The combined therapy, administered as part of a large, long term worldwide study known as ADVANCE, reduced the risk of dying from heart disease by 18%. "If the benefits seen in ADVANCE were applied to just half the population with diabetes worldwide, more than a million deaths would be avoided over five years. For these reasons, there is now a case for considering such treatment routinely for patients with type 2 diabetes," study author John Chalmers, from The George Institute at the University of Sydney in Australia, said in a prepared statement.

By 2030, an estimated 350 million people will be living with diabetes worldwide. Heart disease kills two out of three people with diabetes, who are at increased risk of stroke, heart attacks and related conditions such as degenerative eye disease. Blood pressure management is recommended to reduce the risk of heart disease.

The new findings comes from the ADVANCE trial, which tracked more than 11,100 people with type 2 diabetes from 215 medical centres in 20 countries for four years. The participants, all 55 or older, received either a combination of the ACE inhibitor perindopril and the diuretic indapamide or a placebo.

Over the course of the four years, the researchers found that people with the combined therapy had average reductions in systolic blood pressure of 5-6 mmHg and diastolic blood pressure of 2 mmHg compared with the placebo group.

People who got the combined therapy were 9% less likely to have a heart disease event, such as stroke or heart attack, over the treatment period. They were also 18% less likely to die from heart disease and 14% less likely to die from any cause.

The researchers noted that the impact of the combined therapy occurred regardless of the participant's blood pressure at the beginning of the study.

The study was released online by The Lancet to coincide with a presentation of the research at the European Society of Cardiology meeting in Vienna in September. In an accompanying commentary in the journal, Dr Norman Kaplan, a hypertension expert from the University of Texas Southwestern Medical Center at Dallas, had a caution on the findings. "The fixed combination of perindopril and indapamide could be the best possible protector against hypertension-related consequences for patients with type 2 diabetes, but I believe that other drugs, if they lower blood pressure as much and do not have metabolic side effects, would be as protective as this combination treatment," he said.

And he added, "As has been said many times before by many experts: in most circumstances, lowering the blood pressure is what counts, not the way by which it is lowered."

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Originally posted October 2007.

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