WHEN

MATTE

The 2013 ESH/ESC guidelines recommends

for
Diabetic hypertensive patients
a target BP of

140/85 mm Hg

Excess cardiovascular risk in

diabetic patients is attributable to
coexistent hypertension
Participants with hypertension at the time of
diabetes diagnosis had higher rates of all-cause
mortality and cardiovascular disease than did
people with diabetes without hypertension
All-cause
mortality
Cardiovascul
ar disease
event

Ferrannini E, Cushman WC. Lancet. 2012;380(9841):601-610.

+72%
+57%
For internal use

Achieving BP control in hypertensive

patients with diabetes is A Big

Challenge
n=919
ABPM recordings
T2DM patients with treated hypertension

2015

85%

of hypertensive patients with diabetes have

uncontrolled hypertension

41%

Despite this,
remained on unchanged
antihypertensive therapy

1. Mengden T et al. ABSTRACT/POSTER, ESC 2015.

For internal use

If
If 140
140 is
is your
your
goal,
goal, BiBipreterax
preterax is
is
your
your
BEST
BEST

Rapid BP Reduction

Perindopril / Indapamide
Effecti
Effective
ve
Blood Pressure Reduction

1.
2.
3.
4.

Pella D. High Blood Press Cardiovasc Prev. 2011; 18:107-113.

Farsang C; PICASSO investigators. Blood Press. 2013;22 (Suppl 1):3-10.
Karpov Yu.A, et al; .J Hypertens. 2013;31(e-Suppl A).
Netchessova TA, Shepelkevich AP, Gorbat TV, Lazareva IV; NIKA Study Group. High Blood Press Cardiovasc Prev. ePub ahead of print.

Bi-Preterax provides MORE

27 mm Hg blood pressure reduction

BiPreterax
Farsang C. In press.

Bi-Preterax ensures effective BP

reduction ADAPTED to the severity of
your HT-patients with diabetes

n= 2762 hypertensive patients with

diabetes

Farsang C et al; PICASSO investigators. Adv in Therapy. 2014;31:333-344.

Bi-Preterax
10 Patients

NORMALIZES 9 Out of

9/1
0
*Control rate for systolic (<140 mm Hg) and diastolic blood pressure (<90 mm Hg)
1.
2.
3.
4.

Pella D. High Blood Press Cardiovasc Prev. 2011; 18:107-113.

Farsang C; PICASSO investigators. Blood Press. 2013;22 (Suppl 1):3-10.
Karpov Yu.A, et al; .J Hypertens. 2013;31(e-Suppl A).
Netchessova TA, Shepelkevich AP, Gorbat TV, Lazareva IV; NIKA Study Group. High Blood Press Cardiovasc Prev. ePub ahead of print.

Both Components Provide

24-H EFFICACY

1. Myers MG, et al. Can J Cardiol. 1996;12:1191-1196. 2. Morgan T, Anderson A, et al. Clin Exp Pharmacol Physiol. 1992;19:61-65. 3.
Mallion JM, Asmar R, Boutelant S, et al. J Cardiovasc Pharmacol. 1998;32:673-678. 4. Perticone F, Pugliese F, Ceravolo R, Mattioli PL.
Cardiology.1994;85:36-46. 5. McCarron D, et al. Clin Cardiol.1991;14:737-742. 6. Zannad F, Matzinger A, Larch J. Am J Hypertens.
1996;9:633-643. 7. Lacourcire Y, Poirier L, Lefebvre J, et al. Am J Hypertens.1995;8:1154-1159. 8. Song JC, White CM.
Pharmacotherapy. 2000;20:130-139.

SUPERIORITY OVER COARBs

Bi Preterax SUPERIOR to other

RAASi in controlling Diabetic
hypertensive patients

HIGHER Control Rate

STRONGER BP Control than ARB

16
Clinical Drug Invest 2002: 22 (8): 553-560

Indapamide is significantly more effective

than HCTZ at reducing blood pressure
Additional BP efficacity of Indapamide vs HCTZ
Systematic review and meta-analysis; 10 head-to-head Randomized Clinical Trials comparing HCTZ-indapamide
and HCTZ-chlortalidone at commonly used doses n=883

HCTZ

SBP mm
Hg

CTD

54%

INDAPAMIDE

HCTZ =
Hydrochlorothiazide

CTD = Chlorthalidone
-5.1 mm Hg, (95% CI, 8.7 to 1.6), P=0.004

1. Roush et al. Hypertension. 2015;65(5):1041-1046.

A factorial randomised trial of blood

pressure lowering and intensive
glucose control in 11,140 patients
with type 2 diabetes

Effects on
Mortality
All cause
mortality

1
0

Placebo
Perindoprilindapamide

6 12 18

Relative risk
reduction
14%;
24 30 36p=0.025
42 48 54

60
Follow-up (months)

Cardiovascular
death

1
0

Placebo
Perindoprilindapamide

Relative risk
reduction
18%;
p=0.027

0
0

12 18 24 30 36 42 48 54
60
Follow-up (months)

Patel, MacMahon, Chalmers et al. Lancet

Combined primary
outcome
Perindoprilbo
Indapamide

Percenta
ges

2
0

Major macro or microvascular

Place
event

1
0

Relative risk
reduction 9%: 95%
CI: 0 to 17%
p=0.041
0 0

1
2

1
8

24

30

36

Follow-up
(months)

4
2

4
8

5
4

6
0

Patel, MacMahon, Chalmers et al. Lancet

Summary-ADVANCE
Blood pressure lowering arm

Treatment of patients with type 2

diabetes
with Perindopril-Indapamide
resulted in:
14% reduction in total mortality
18% reduction in cardiovascular death
9% reduction in major vascular events
14% reduction in total coronary events
21% reduction in total renal events
Benefits appeared to be independent of
initial blood pressure, similar in all

ADVANCE post trial ObservatioNal

Study
BP Arm Results

ADVANCE-ON in the 2015

American Diabetes Association
guidelines

BP levels: in-trial and post

trial
(before and after stopping randomised
treatment)

Mortality

Cumulative
incidence (%)

(Overall follow-up)

HR 0.91 (0.84,
0.99); P=0.03

HR 0.88 (0.77,
0.99); P=0.04

Placebo
Perindo
prilIndapam
ide

All cause
mortality

Follow-up
(years)

Cardiovascular
death

RAAS I and Nephropathy

IDNT
RENAAL

IRMA 2
TRANSCE
ND

The IDNT and RENAAL trials. Despite the

renal benefits in both trials, ARB treatment
did not produce any substantial or
significant improvement in the risk of all
CV events or in all-cause or CV mortality.

Irbesartan & Telmisartan had no significant effect

on the main composite CV endpoint, or on allcause or CV death. The authors concluded that
ARBs offer no renal benefit in ACE-intolerant
people at high vascular risk but without
macroalbuminuria.

B
IR
N significant

TRANSCE
ND
TELMISARTAN

IR
D
C

Olmesartan

none of the trials showed a

benefit of ARBs on mortality. The
lack of significant effect might be expected
in trials with relatively small numbers of
deaths, such as IRMA 2 and DIRECT.
However, it is of more concern in those trials,
which, because of their large size and/or the
high-risk nature of their patients, involved
substantial numbers of deaths, or, as in
ROADMAP, showed an increased rate of
cardiovascular death with ARB treatment.

n
ta

ROADMAP

ar
es

TA
R
A
ES

M
IR

Losartan

b
Ir

N
ID
T However,

RENAAL

T
C
E

es
d
an

an
t
ar

Kidney protection that translates

into mortality reduction

Adapted from Garca-Donaire JA, Segura J, Cerezo C, Ruilope LM. Blood Pressure.
2011;20:322-334.

The only stroke reduction

translating into life-saving
benefits

1. Furie KL, Kasner SE, Adams RJ, et al. Stroke. 2011;42;227-276. 2. MacMahon S, Neal B, Tzourio C, et al. Lancet. 2001;358:1033-1041.
3. Yusuf S, Sleight P, Dagenais G, et al. N Engl J Med. 2000;342:145-153. 4. Rashid P, Leonardi-Bee J, Bath P. Stroke. 2003;34:27412749. 5. Yusuf S, Diener HC, Sacco RL, et al. N Engl J Med. 2008;359:1225-1237. 6. Schrader J, Lders S, Kulschewskiet A, et al. Stroke.
2005;36:1218-1224. 7. Algra A, van Gijn J, Kappelle LJ, et al. Stroke. 1993;24:543-548. 8. Lisheng L, Zhang LG, Peto R, et al. Chin Med
J. 1995;108:710-717.

SAFETY PROFILE

Perindopril/Indapamide
is highly appreciated
Tolerability rated
good or very
good by:
Patients: 98%
Doctors: 99%

Netchessova TA, Shepelkevich AP, Gorbat TV, Lazareva IV; NIKA Study Group. High Blood Press Cardiovasc Prev. ePub ahead of print.

Perindopril/Indapamide Improves
the Patients Metabolic Profile

Indapamide:
The Diuretic Providing The Best
Protection

1. Ambrosioni E, Safar M, Degautec J-P, et al. J Hypertens. 1998;16:1677-1684. 2. Akram J, Sheikh UE, Mahmood M, et al. Curr
Med Res Opin. 2007;23:2929-2936. 3. Gaciong Z, Symonides B. Expert Opin Pharmacother. 2010;11:2579-2597. 4. Beckett NS,
Peters R, Fletcher AE, et al. N Engl J Med. 2008;358:1887-1898. 5. Gosse P, Sheridan DJ, Zannad F, et al. J Hypertens.
2000;18:1465-1475. 6. Marre M, Garcia J, Kokot F, et al. J Hypertens. 2004;22:1613-1622.

Your reference treatment for

hypertensive patients with diabetes

Effective
blood
pressure
reduction
Life-saving
benefits
Optimal
tolerability
profile

4 Endorsed By
guidelines

Perindopril / Indapamide ensures effective

blood pressure reduction, which is adapted
to the severity of patients with diabetes
Bi Preterax controls 9 patients with diabetes
out of 10

Perindopril / Indapamide significantly

reduces total mortality by 9% and
cardiovascular mortality by 12% over 10
years

Perindopril / Indapamide improves the

metabolic profile of patients with diabetes
with a Tolerability acknowledged by doctors
and patients

Perindopril / Indapamide is the ADA 2015

reference treatment for Diabetic
hypertensive patients.

Conclusion
Bi preterax provides Powerful BP
reduction

-45/-21

mmHg SBP/DBP.
Rapid BP control.
Triple action at the renal level.
Cardio vascular protection.
Total mortality reduction.
ARBs are not equal to ACEi

Saves Lives

60