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Clinical Articles, Lead Article


Risk of death in patients with atrial fibrillation (AF) and type 2 diabetes can be substantially reduced by hypertension treatment with perindopril/indapamide, according to findings announced recently by the European Society of Cardiology (ESC).1

The ESC highlights follow-up data released since the first publication of the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation) trial,2 regarding the occurrence of AF in patients with diabetes and the impact of the perindopril/indapamide fixed combination on it.

One referenced study3 randomised 11,140 patients with type 2 diabetes (7.6% of whom had AF at baseline) to a fixed combination of perindopril/indapamide or placebo.  It compared total mortality and cardiovascular disease outcomes, and the effect on them of randomised treatment for 4.3 years, between patients with and without AF at baseline.  AF was associated with a 61% greater risk of all-cause mortality and comparable higher risks of cardiovascular death, stroke, and heart failure (all p < 0.001).

Routine treatment with a fixed combination of perindopril and indapamide was found to produce similar relative, but greater absolute, risk reductions for all-cause and cardiovascular mortalities in patients with AF, compared with those without AF.

A further set of data are reported, relating to the combination’s effect on blood pressure.  Initially found to reduce all-cause mortality (-14%), cardiovascular mortality (-18%) and major cardiovascular events (-9%), it has since been shown that perindopril/indapamide:

  • Has detectable beneficial effects in a wide range of patient subgroups according to a) blood pressure values at study entry < or > 140/90 mmHg, b) presence or absence of other blood pressure lowering treatments, or c) concomitant administration of statins and/or antiplatelet agents
  • Has similar efficacy and safety, as well as a similar risk reduction for primary and secondary endpoints in patients aged below 65 years and in those aged 75 years or more
  • Has blood pressure lowering effects that are not affected by a given patient’s cognitive dysfunction even though cognitive dysfunction will increase the risk of cardiovascular outcomes
  • Intervenes effectively on the cardiovascular risk profile diabetic patients
  • Holds significantly greater benefit in terms of risk reduction in high risk patients


1 Grassi G, Mancia G.  The ADVANCE trial – new findings and updated results: An article from the e-journal of the ESC Council for Cardiology Practice, 2011;9:No.29.

Available from:

2 Patel A, MacMahon S, Chalmers J, et al.  Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007;370:829-40.

3 Du X, Ninomiya T, de Galan B, et al. Risks of cardiovascular events and effects of routine blood pressure lowering among patients with type 2 diabetes and atrial fibrillation: results of the ADVANCE study.  Eur Heart J 2009;30:1128-35.

Published on: June 8, 2011

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  • ArrhythmiaAlliance
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