The study was called ADVANCE -- or Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation -- and was conducted in 215 centers in 20 Asian, Australasian, European and North American countries.

    It tested the effects of Preterax, an anti-hypertensive tablet with a combination of two drugs, and Diamicron MR, an anti-diabetic tablet, on 11,140 patients of non-insulin dependent or Type 2 diabetes.

    According to co-principal investigator of the trial Dr. John Chalmers, senior director of the George Institute of International Health in Sydney, Australia, there are 250 million diabetics in the world today and the number is predicted to increase to 380 million in the next two decades.

    Studies have shown that diabetics are more at risk of dying or becoming disabled due to complications related to their veins and arteries, rather than because of the metabolic abnormalities of the disease itself.

    Elevated blood pressure causes pathological changes in the blood vessels, causing heart failure, heart attack, stroke, renal failure and decreased vision; hence it is an important measure of death and disability in diabetics.

    Normal blood pressure varies from individual to individual although it has been arbitrarily stated that 120/80 mm of mercury is the most ideal value. In all people, blood pressure rises with age. Any variation from the normal blood pressure for prolonged periods can be said to be abnormal and needs treatment.

    The danger of suffering from heart diseases due to high blood pressure depends to a great extent upon other associated factors in that particular person. These comprise habits like smoking, alcoholism, a sedentary lifestyle and pre-existing conditions like family history, obesity, high blood cholesterol and diabetes.

    The more the risk factors, the higher the chance of suffering from a stroke or heart attack. Similarly, studies have also shown that elimination of risk factors also diminishes the chances of complications.

    In the ADVANCE study, scientists were especially interested in the benefits of lowering blood pressure in diabetics who were not hypertensive. The patients selected were older than 55 years, with long-standing diabetes, with and without hypertension, and were randomly divided into two groups. Only one group was treated with Preterax. All patients were followed for a period of 4.3 years.

    At the end of the study, it was noted that blood pressures fell to an average of 134.7/ 77 mm Hg in the active group receiving Preterax as against 140.3/ 74.8 mm Hg in the placebo group which did not receive it.

    There was significant reduction of general mortality in the active group, occurring twelve months after starting the treatment. There was also significant decrease in the coronary artery disease events in the heart, like heart attacks, and kidney diseases.

    Most importantly, the advantages were noticeable in all patients, with and without hypertension, irrespective of whether they were taking other medicines like lipid- reducing drugs, aspirin or anti-platelet drugs.

    It was concluded that an aggressive five year anti-hypertensive treatment plan prevents heart and kidney diseases and reduces subsequent deaths.

    According to Dr. Guiseppe Mancia, who heads the department of internal medicine at San Gerado Hospital in Monza, Italy, and is a member of the ADVANCE management committee, there is more protection with more aggressive blood pressure reduction.

    Dr. Mancia believes there is always an advantage in lowering the blood pressure in a diabetic, even if it is not high. Since this is a high risk patient, it makes sense not to waste time, as uncontrolled blood pressure, for even a short time, can translate into high chances of cardiovascular events like heart attacks.

    Hypertension is responsible for one in every eight deaths globally, according to the World Health Organization. Perhaps this number could be reduced in the future by following the guidelines from the ADVANCE trial, which has shown an easy, effective and safe way of decreasing blood pressure and improving the quality of life in a diabetic.

    --

    (Dr. Pradnya Kulkarni is a clinical pathologist from India. She worked as a consultant pathologist in a private laboratory in Pune before moving to Hong Kong with her husband and young daughter. She is also a freelance writer, focusing on medical issues of public concern. ©Copyright Pradnya Kulkarni.)

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