03573nas a2200481   4500000000100000008004100001653001100042653001100053653000900064653002200073653000900095653002200104653001700126653001700143653004400160653002900204653003300233653006700266653007400333653002200407653004000429653002400469653004000493653004100533100001500574700001700589700001400606700001800620700001600638700001500654700001500669700001300684700002100697700002100718700001600739700001500755245025200770250001501022300001101037490000701048520198501055020005103040       2015                            d10aFemale10aHumans10aAged10aFollow-Up Studies10aMale10aTreatment Outcome10aRisk Factors10aTime Factors10aAntihypertensive Agents/therapeutic use10aBlood Glucose/metabolism10aBlood Pressure/ drug effects10aCardiovascular Diseases/ drug therapy/etiology/physiopathology10aDiabetes Mellitus, Type 2/complications/ drug therapy/physiopathology10aDrug Combinations10aGliclazide/ administration & dosage10aHypoglycemic Agents10aIndapamide/ administration & dosage10aPerindopril/ administration & dosage1 aZoungas S.1 aGlass Parisa1 aKengne A.1 aWoodward Mark1 aVisseren F.1 aPoulter N.1 aGrobbee D.1 aHamet P.1 avan der Leeuw J.1 avan der Graaf Y.1 aChalmers J.1 aMacmahon S00aPredicting 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  a2014/10/15  a115-210 v653 a<p>
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 &gt;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 &gt;/=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% (NNT5-->/=200) 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. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00145925.
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