Effect of intensive blood pressure and blood glucose control on cardiovascular outcomes driven by reductions in cardiovascular death and nephropathy: win ratio analysis of ADVANCE trial
Authors' conclusion
The win ratio approach confirms the robustness of the original ADVANCE findings while providing a more detailed understanding of the relative importance of individual outcomes. This method enhances the interpretation and communication of composite endpoint analyses.
Study context
- Population
- Participants of the ADVANCE trialparticipants of the ADVANCE trial
- Participants
- 11,140 participants
- Comparison
- Comparing intervention and control groups for blood pressure and glucose control
- Outcome
- Hierarchical composite (cardiovascular death, non-fatal stroke, non-fatal myocardial infarction, nephropathy, retinopathy): blood pressure lowering
Methodological detailsre-analysis of the ADVANCE trial
- Re-analysis of the ADVANCE trial
Main finding
As reported in the abstract
perindopril-indapamide vs placeboWin ratio (95% CI)P value
Hierarchical composite (cardiovascular death, non-fatal stroke, non-fatal myocardial infarction, nephropathy, retinopathy): blood pressure lowering
1.11(1.01–1.22)
P = 0.028- NNT of 68 patients
- net benefit 1.5% (95% CI 0.2%–2.8%)
Further findings
| Outcome | Win ratio (95% CI) | P value | |
|---|---|---|---|
| Hierarchical composite: intensive glucose controlIntensive glucose control vs standard glucose control | 1.10 (1.01–1.20) | P = 0.027 | |
| 0.512Win ratio (log scale) |
| Outcome | Net benefit (95% CI) |
|---|---|
| Hierarchical composite: intensive glucose controlIntensive glucose control vs standard glucose control · NNT of 63 patients | 1.6% (0.2%–3.0%) |
Hierarchical composite: both interventions combined
- Win ratio
- 1.19 (95% CI 1.04-1.35, P = 0.010)
- NNT
- 41 patients
Contributors to benefit
- Cardiovascular death and nephropathy were the main contributors to the observed benefits
Original publication
Effect of intensive blood pressure and blood glucose control on cardiovascular outcomes driven by reductions in cardiovascular death and nephropathy: win ratio analysis of ADVANCE trial. Eur Heart J Cardiovasc Pharmacother. Published 29 April 2026. doi:10.
Summarised from the published abstract; every number is checked against it