HbA1c averaged 7.8% at baseline and decreased by 0.3% in the placebo group and by 0.8% in those on active therapy. There was no significant difference between treatment groups in the primary study endpoint, although pioglitazone resulted in a statistically significant 16% relative reduction in a secondary endpoint of mortality, nonfatal MI, and stroke.581 Three studies in patients with type 2 diabetes mellitus suggest that even more intensive glucose lowering fails to reduce the incidence of cardiovascular events and could cause harm.576,578,600 The ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation) trial tested a strategy of intensive glucose control with a target HbA1c of 6.5%, with the Table 15. Indications for Individual Drug Classes in the Treatment of Hypertension in Patients With SIHD* Indication Recommended Drugs Diuretic Beta Blocker ACE Inhibitor ARB Calcium-Channel Blocker Aldosterone Antagonist Heart failure LV dysfunction After myocardial infarction Angina Diabetes mellitus Chronic kidney disease *Table indicates drugs that should be considered and does not indicate that all drugs should necessarily be prescribed in an individual patient (eg, ACE inhibitors and ARB typically are not prescribed together). ACE indicates angiotensin-converting enzyme; ARB, angiotensin-receptor blocker; and LV, left ventricular. sulfonylurea gliclazide (modified release) and other drugs used as required.576 After a median 5 years of follow-up, HbA1c averaged 6.5% in the intensive-control group and 7.3% in the standard-control group. 