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MeReC Extra 38

The National Prescribing Centre (NPC) has published MeReC Extra 38 (PDF).

This MeReC discusses the results of the Veterans Association Diabetes Trial (VADT) and the recently published ACCOMPLISH Study.

VADT involved 1,791 US military veterans with uncontrolled type 2 diabetes (HbA1c >7.5%, baseline median 9.4%). Participants were treated to an intensive or standard targets reaching an HbA1c 6.9% or 8.4% respectively.

Despite the lower HbA1c in the intensive arm there were no differences in major cardiovascular events or deaths from any cause. These results are in keeping with a growing body of evidence; cardiovascular risk in patients with diabetes is best managed with lifestyle interventions, blood pressure control, statins, metformin and aspirin in cases of secondary prevention.

The ACCOMPLISH study compared two strategies for treating hypertension and found that a combination of ACE inhibitor and calcium channel blocker was superior to that of ACE inhibitor and diuretic in terms of the primary composite outcome (a composite of six cardiovascular outcomes). The results were mainly driven by differences in fatal and nonfatal myocardial infarction but there was no difference in rates of cardiovascular or all cause death.

The results are of limited relevance to the UK because the drugs studied are not available on the UK market. In addition there was a small difference in mean blood pressure in the two groups that favoured the superior treatment and this may also explain some of the observed difference. Clinicians are advised to continue to follow the existing NICE guidelines.

Action: Clinicians who see patients with hypertension or diabetes will find this information useful and informative.