Effects of glucose and blood pressure reduction on subclinical cardiac damage: Results from ADVANCE

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Title: Effects of glucose and blood pressure reduction on subclinical cardiac damage: Results from ADVANCE
Authors: Juraschek, SP
Wang, D
McEvoy, JW
Harrap, S
Harris, K
Mancia, G
Marre, M
Neal, B
Patel, A
Poulter, NR
Williams, B
Chalmers, J
Woodward, M
Selvin, E
Item Type: Journal Article
Abstract: OBJECTIVE: Observational data suggest a potential for subclinical cardiac damage from intensive blood glucose or blood pressure (BP) control, particularly in adults with very low blood glucose and BP levels. However, this has not been tested in a randomized trial. METHODS: The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Research Controlled Evaluation (ADVANCE) study was a factorial, randomized trial designed to test the effects of intensive blood glucose (hemoglobin A1c ≤6.5% versus usual care) and intensive BP (combination of perindopril-indapamide versus placebo) control on vascular events in adults with diabetes. Using mixed effects tobit models, we determined the effect of the randomized interventions on change in subclinical cardiac injury (high sensitivity cardiac troponin T [hs-cTnT]) and strain (N-terminal b-type pro natriuretic peptide [NT-proBNP]), 1 year after randomization. RESULTS: Among the 682 participants, mean age was 66.1 (SD, 6.5) years; 40% were women. Mean baseline hemoglobin A1c was 7.4% (SD, 1.5) and systolic/diastolic BP was 147 (SD,21)/81 (SD,11) mmHg. After 1 year, intensive versus standard glucose control did not significantly change hs-cTnT (1.5%; 95%CI:-4.9,8.2) or NT-proBNP (-10.3%; 95%CI: -20.2%,0.9%). Intensive versus standard BP control also did not affect hs-cTnT (-2.9%; 95%CI: -8.9,3.6), but did significantly lower NT-proBNP by 21.6% (95%CI:-30.2%,-11.9%). Changes in systolic BP at 1 year (versus baseline) were strongly associated with NT-proBNP (P = 0.004), but not hs-cTnT (P = 0.95). CONCLUSIONS: In adults with diabetes, intensive BP control reduced NT-proBNP without increasing hs-cTnT, supporting the benefits and safety of intensive BP control in adults with diabetes. This trial is registered at clinicaltrials.gov, number: NCT00145925.
Issue Date: 1-Jul-2022
Date of Acceptance: 13-Apr-2022
URI: http://hdl.handle.net/10044/1/97504
DOI: 10.1016/j.ijcard.2022.04.044
ISSN: 0167-5273
Publisher: Elsevier
Start Page: 103
End Page: 109
Journal / Book Title: International Journal of Cardiology
Volume: 358
Copyright Statement: © 2022 Elsevier B.V. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: Blood glucose treatment
Blood pressure treatment
Diabetes
High sensitivity cardiac troponin T
N-terminal b-type pro natriuretic peptide
Trial
Aged
Biomarkers
Blood Glucose
Blood Pressure
Female
Glucose
Glycated Hemoglobin A
Humans
Hypotension
Male
Middle Aged
Natriuretic Peptide, Brain
Peptide Fragments
Troponin T
Humans
Hypotension
Natriuretic Peptide, Brain
Glucose
Blood Glucose
Peptide Fragments
Troponin T
Blood Pressure
Aged
Middle Aged
Female
Male
Biomarkers
Glycated Hemoglobin A
Blood glucose treatment
Blood pressure treatment
Diabetes
High sensitivity cardiac troponin T
N-terminal b-type pro natriuretic peptide
Trial
Aged
Biomarkers
Blood Glucose
Blood Pressure
Female
Glucose
Glycated Hemoglobin A
Humans
Hypotension
Male
Middle Aged
Natriuretic Peptide, Brain
Peptide Fragments
Troponin T
Cardiovascular System & Hematology
1102 Cardiorespiratory Medicine and Haematology
1117 Public Health and Health Services
Publication Status: Published
Conference Place: Netherlands
Embargo Date: 2023-04-17
Online Publication Date: 2022-04-18
Appears in Collections:School of Public Health



This item is licensed under a Creative Commons License Creative Commons