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Triple Combination Therapy in Hypertension: The Antihypertensive Efficacy of Treatment with Perindopril, Amlodipine, and Indapamide SR

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Abstract

Background and Objective

The blood pressure (BP) of most patients on antihypertensive monotherapy or bitherapy remains uncontrolled. Our study evaluated the efficacy of triple therapy with perindopril, amlodipine, and indapamide sustained release (SR) in patients with uncontrolled hypertension on previous antihypertensive therapy.

Methods

This 4-month, multicenter, prospective, observational, open-label study included patients switched from previous antihypertensive therapy to triple therapy with perindopril, amlodipine, and indapamide SR. The main outcome was change in office BP from baseline to 4 months, as well as changes in 24-h ambulatory BP monitoring (ABPM) parameters in a subgroup of patients.

Results

Age was 62.8 ± 11.3 years in 6,088 patients (55 % were male). Office BP at baseline was 158.1 ± 13.0/92.6 ± 8.8 mmHg. By 4 months, office BP decreased by 26.7 ± 13.3/12.9 ± 9.4 mmHg (p < 0.001). ABPM was performed in 62 patients. In these patients, 24-h systolic BP decreased (from 138.7 ± 12.5 to 125.5 ± 12.8 mmHg), as did 24-h diastolic BP (from 77.5 ± 11.4 to 70.4 ± 8.7 mmHg) (both p < 0.0001). Heart rate remained unchanged. In patients previously on renin-angiotensin-aldosterone system (RAAS) inhibitor/amlodipine, 24-h ambulatory systolic and diastolic BP decreased from 136.9 ± 12.8 to 125.4 ± 13.3 mmHg (p = 0.0003) and from 76.3 ± 12.6 to 70.2 ± 9.5 mmHg (p = 0.0005). In those previously on RAAS inhibitor/hydrochlorothiazide, 24-h ambulatory systolic and diastolic BP decreased from 137.8 ± 12.7 to 122.7 ± 15.4 mmHg (p = 0.0039) and from 73.6 ± 9.4 to 65.7 ± 7.3 mmHg (p = 0.002). Most (74 and 80 %, respectively) patients reached target ABPM values (<130/80 mmHg).

Conclusion

A triple combination of perindopril, amlodipine, and indapamide SR controlled BP effectively in hypertensive patients uncontrolled by previous antihypertensive monotherapy or bitherapy, including RAAS inhibitor/amlodipine or RAAS inhibitor/hydrochlorothiazide combinations.

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Conflict of interest

This study was sponsored by Egis Pharmaceuticals PLC, Hungary. Dénes Páll has received research grant, speaker’s bureau fees and consultancy fees from Egis and Servier. He has no other conflicts of interest to declare that are relevant to content of the present study. Ildikó Szántó and Zoltán Szabó have no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Medicine, Clinical Center, University of Debrecen, Nagyerdei krt 98 Pf 19, 4032, Debrecen, Hungary

    Dénes Páll, Ildikó Szántó & Zoltán Szabó

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  1. Dénes Páll
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  2. Ildikó Szántó
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  3. Zoltán Szabó
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Correspondence to Dénes Páll.

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on behalf of the PAINT Investigators.

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Páll, D., Szántó, I. & Szabó, Z. Triple Combination Therapy in Hypertension: The Antihypertensive Efficacy of Treatment with Perindopril, Amlodipine, and Indapamide SR. Clin Drug Investig 34, 701–708 (2014). https://doi.org/10.1007/s40261-014-0223-0

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