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Predicting the effects of blood pressure-lowering treatment on major cardiovascular events for individual patients with type 2 diabetes mellitus results from action in diabetes and vascular disease : Preterax and diamicron mr controlled evaluation

Blood pressure-lowering treatment reduces cardiovascular risk in patients with diabetes mellitus, but the effect varies between individuals. We sought to identify which patients benefit most from such treatment in a large clinical trial in type 2 diabetes mellitus. In Action in Diabetes and Vascular... Full description

Journal Title: Hypertension (Dallas Tex. 1979), 2015-01-01, Vol.65 (1), p.115-121
Main Author: Van Der Leeuw, Joep
Other Authors: Visseren, Frank L J , Woodward, Mark , Zoungas, Sophia , Kengne, Ane Pascal , Van Der Graaf, Yolanda , Glasziou, Paul , Hamet, Pavel , MacMahon, Stephen , Poulter, Neil , Grobbee, DE , Chalmers, John
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: United States: American Heart Association, Inc
ID: ISSN: 0194-911X
Link: https://www.ncbi.nlm.nih.gov/pubmed/25312436
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title: Predicting the effects of blood pressure-lowering treatment on major cardiovascular events for individual patients with type 2 diabetes mellitus results from action in diabetes and vascular disease : Preterax and diamicron mr controlled evaluation
format: Article
creator:
  • Van Der Leeuw, Joep
  • Visseren, Frank L J
  • Woodward, Mark
  • Zoungas, Sophia
  • Kengne, Ane Pascal
  • Van Der Graaf, Yolanda
  • Glasziou, Paul
  • Hamet, Pavel
  • MacMahon, Stephen
  • Poulter, Neil
  • Grobbee, DE
  • Chalmers, John
subjects:
  • Aged
  • Antihypertensive Agents
  • Antihypertensive Agents - therapeutic use
  • Blood Glucose - metabolism
  • Blood Pressure - drug effects
  • Cardiovascular Diseases - drug therapy
  • Cardiovascular Diseases - etiology
  • Cardiovascular Diseases - physiopathology
  • Diabetes Mellitus
  • Diabetes Mellitus, Type 2 - complications
  • Diabetes Mellitus, Type 2 - drug therapy
  • Diabetes Mellitus, Type 2 - physiopathology
  • Drug Combinations
  • Female
  • Follow-Up Studies
  • Gliclazide - administration & dosage
  • Humans
  • Hypoglycemic Agents
  • Indapamide - administration & dosage
  • Individualized Medicine
  • Internal Medicine
  • Journal Article
  • Male
  • Medical Decision
  • Medicine(all)
  • Multicenter Study
  • Perindopril - administration & dosage
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Risk Factors
  • Time Factors
  • Treatment Outcome
ispartof: Hypertension (Dallas, Tex. 1979), 2015-01-01, Vol.65 (1), p.115-121
description: Blood pressure-lowering treatment reduces cardiovascular risk in patients with diabetes mellitus, but the effect varies between individuals. We sought to identify which patients benefit most from such treatment in a large clinical trial in type 2 diabetes mellitus. In Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) participants (n=11 140), we estimated the individual patient 5-year absolute risk of major adverse cardiovascular events with and without treatment by perindopril-indapamide (4/1.25 mg). The difference between treated and untreated risk is the estimated individual patient's absolute risk reduction (ARR). Predictions were based on a Cox proportional hazards model inclusive of demographic and clinical characteristics together with the observed relative treatment effect. The group-level effect of selectively treating patients with an estimated ARR above a range of decision thresholds was compared with treating everyone or those with a blood pressure
language: eng
source:
identifier: ISSN: 0194-911X
fulltext: no_fulltext
issn:
  • 0194-911X
  • 1524-4563
url: Link


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titlePredicting the effects of blood pressure-lowering treatment on major cardiovascular events for individual patients with type 2 diabetes mellitus results from action in diabetes and vascular disease : Preterax and diamicron mr controlled evaluation
creatorVan Der Leeuw, Joep ; Visseren, Frank L J ; Woodward, Mark ; Zoungas, Sophia ; Kengne, Ane Pascal ; Van Der Graaf, Yolanda ; Glasziou, Paul ; Hamet, Pavel ; MacMahon, Stephen ; Poulter, Neil ; Grobbee, DE ; Chalmers, John
creatorcontribVan Der Leeuw, Joep ; Visseren, Frank L J ; Woodward, Mark ; Zoungas, Sophia ; Kengne, Ane Pascal ; Van Der Graaf, Yolanda ; Glasziou, Paul ; Hamet, Pavel ; MacMahon, Stephen ; Poulter, Neil ; Grobbee, DE ; Chalmers, John
descriptionBlood pressure-lowering treatment reduces cardiovascular risk in patients with diabetes mellitus, but the effect varies between individuals. We sought to identify which patients benefit most from such treatment in a large clinical trial in type 2 diabetes mellitus. In Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) participants (n=11 140), we estimated the individual patient 5-year absolute risk of major adverse cardiovascular events with and without treatment by perindopril-indapamide (4/1.25 mg). The difference between treated and untreated risk is the estimated individual patient's absolute risk reduction (ARR). Predictions were based on a Cox proportional hazards model inclusive of demographic and clinical characteristics together with the observed relative treatment effect. The group-level effect of selectively treating patients with an estimated ARR above a range of decision thresholds was compared with treating everyone or those with a blood pressure <140/90 mm Hg using net benefit analysis. In ADVANCE, there was wide variation in treatment effects across individual patients. According to the algorithm, 43% of patients had a large predicted 5-year ARR of 1% (number-needed-to-treat [NNT5] 100) and 40% had an intermediate predicted ARR of 0.5% to 1% (NNT5=100-200). The proportion of patients with a small ARR of 0.5% (NNT5200) was 17%. Provided that one is prepared to treat at most 200 patients for 5 years to prevent 1 adverse outcome, prediction-based treatment yielded the highest net benefit. In conclusion, a multivariable treatment algorithm can identify those individuals who benefit most from blood pressure-lowering therapy in terms of ARR of major adverse cardiovascular events and may be used to guide treatment decisions in individual patients with diabetes.
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subjectAged ; Antihypertensive Agents ; Antihypertensive Agents - therapeutic use ; Blood Glucose - metabolism ; Blood Pressure - drug effects ; Cardiovascular Diseases - drug therapy ; Cardiovascular Diseases - etiology ; Cardiovascular Diseases - physiopathology ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - drug therapy ; Diabetes Mellitus, Type 2 - physiopathology ; Drug Combinations ; Female ; Follow-Up Studies ; Gliclazide - administration & dosage ; Humans ; Hypoglycemic Agents ; Indapamide - administration & dosage ; Individualized Medicine ; Internal Medicine ; Journal Article ; Male ; Medical Decision ; Medicine(all) ; Multicenter Study ; Perindopril - administration & dosage ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't ; Risk Factors ; Time Factors ; Treatment Outcome
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1Visseren, Frank L J
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3Zoungas, Sophia
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6Glasziou, Paul
7Hamet, Pavel
8MacMahon, Stephen
9Poulter, Neil
10Grobbee, DE
11Chalmers, John
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descriptionBlood pressure-lowering treatment reduces cardiovascular risk in patients with diabetes mellitus, but the effect varies between individuals. We sought to identify which patients benefit most from such treatment in a large clinical trial in type 2 diabetes mellitus. In Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) participants (n=11 140), we estimated the individual patient 5-year absolute risk of major adverse cardiovascular events with and without treatment by perindopril-indapamide (4/1.25 mg). The difference between treated and untreated risk is the estimated individual patient's absolute risk reduction (ARR). Predictions were based on a Cox proportional hazards model inclusive of demographic and clinical characteristics together with the observed relative treatment effect. The group-level effect of selectively treating patients with an estimated ARR above a range of decision thresholds was compared with treating everyone or those with a blood pressure <140/90 mm Hg using net benefit analysis. In ADVANCE, there was wide variation in treatment effects across individual patients. According to the algorithm, 43% of patients had a large predicted 5-year ARR of 1% (number-needed-to-treat [NNT5] 100) and 40% had an intermediate predicted ARR of 0.5% to 1% (NNT5=100-200). The proportion of patients with a small ARR of 0.5% (NNT5200) was 17%. Provided that one is prepared to treat at most 200 patients for 5 years to prevent 1 adverse outcome, prediction-based treatment yielded the highest net benefit. In conclusion, a multivariable treatment algorithm can identify those individuals who benefit most from blood pressure-lowering therapy in terms of ARR of major adverse cardiovascular events and may be used to guide treatment decisions in individual patients with diabetes.
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1Antihypertensive Agents
2Antihypertensive Agents - therapeutic use
3Blood Glucose - metabolism
4Blood Pressure - drug effects
5Cardiovascular Diseases - drug therapy
6Cardiovascular Diseases - etiology
7Cardiovascular Diseases - physiopathology
8Diabetes Mellitus
9Diabetes Mellitus, Type 2 - complications
10Diabetes Mellitus, Type 2 - drug therapy
11Diabetes Mellitus, Type 2 - physiopathology
12Drug Combinations
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15Gliclazide - administration & dosage
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26Perindopril - administration & dosage
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31Treatment Outcome
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7Hamet, Pavel
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titlePredicting the effects of blood pressure-lowering treatment on major cardiovascular events for individual patients with type 2 diabetes mellitus results from action in diabetes and vascular disease : Preterax and diamicron mr controlled evaluation
authorVan Der Leeuw, Joep ; Visseren, Frank L J ; Woodward, Mark ; Zoungas, Sophia ; Kengne, Ane Pascal ; Van Der Graaf, Yolanda ; Glasziou, Paul ; Hamet, Pavel ; MacMahon, Stephen ; Poulter, Neil ; Grobbee, DE ; Chalmers, John
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30Time Factors
31Treatment Outcome
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7Hamet, Pavel
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2Woodward, Mark
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7Hamet, Pavel
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atitlePredicting the effects of blood pressure-lowering treatment on major cardiovascular events for individual patients with type 2 diabetes mellitus results from action in diabetes and vascular disease : Preterax and diamicron mr controlled evaluation
jtitleHypertension (Dallas, Tex. 1979)
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pages115-121
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abstractBlood pressure-lowering treatment reduces cardiovascular risk in patients with diabetes mellitus, but the effect varies between individuals. We sought to identify which patients benefit most from such treatment in a large clinical trial in type 2 diabetes mellitus. In Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) participants (n=11 140), we estimated the individual patient 5-year absolute risk of major adverse cardiovascular events with and without treatment by perindopril-indapamide (4/1.25 mg). The difference between treated and untreated risk is the estimated individual patient's absolute risk reduction (ARR). Predictions were based on a Cox proportional hazards model inclusive of demographic and clinical characteristics together with the observed relative treatment effect. The group-level effect of selectively treating patients with an estimated ARR above a range of decision thresholds was compared with treating everyone or those with a blood pressure <140/90 mm Hg using net benefit analysis. In ADVANCE, there was wide variation in treatment effects across individual patients. According to the algorithm, 43% of patients had a large predicted 5-year ARR of 1% (number-needed-to-treat [NNT5] 100) and 40% had an intermediate predicted ARR of 0.5% to 1% (NNT5=100-200). The proportion of patients with a small ARR of 0.5% (NNT5200) was 17%. Provided that one is prepared to treat at most 200 patients for 5 years to prevent 1 adverse outcome, prediction-based treatment yielded the highest net benefit. In conclusion, a multivariable treatment algorithm can identify those individuals who benefit most from blood pressure-lowering therapy in terms of ARR of major adverse cardiovascular events and may be used to guide treatment decisions in individual patients with diabetes.
copUnited States
pubAmerican Heart Association, Inc
pmid25312436
doi10.1161/HYPERTENSIONAHA.114.04421
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