Background: The Action in Diabetes and Vascular Disease
(ADVANCE) Study demonstrated that a fixed combination of
perindopril and indapamide reduced the risk of major vascular
events and mortality in patients with type 2 diabetes. This
Echocardiographic Substudy was designed to determine the effects of
this treatment on left ventricular diastolic function and left
ventricular mass.
Methods: Five hundred and fifty-five patients entering
ADVANCE underwent quantitative echocardiography prior to
randomization and after 6 months and 4 years of treatment with
perindopril–indapamide or placebo. Main end points were left
ventricular diastolic function (ratio of mitral E
velocity/early medial mitral annular tissue Doppler velocity,
E/Em, and left atrial volume index) and left ventricular
mass index.
Results: Overall, blood pressure was reduced in the
perindopril–indapamide group compared with placebo.
E/Em and left atrial volume index both increased over the
4 years. There was no effect of perindopril–indapamide on
E/Em, although there was a small attenuation of the
increase in left atrial volume index with active treatment. Left
ventricular mass index was reduced by 2.7 g/m2 with
active treatment (95% confidence interval −5.0 to −0.1,
P = 0.04).
Conclusion: Compared with placebo, the
perindopril–indapamide combination reduced blood pressure and
left ventricular mass in patients with diabetes, but did not
improve left ventricular diastolic function. Left ventricular
diastolic function worsened in both groups over 4 years, despite
blood pressure reduction and reduction in left ventricular mass.
Improving left ventricular diastolic function remains a challenge
in patients with diabetes.
