Abstract
Background
Current guidelines recommend the use of full therapeutic dosages of antihypertensive agents, or combination therapy, to improve BP control of hypertensive patients in primary healthcare.
Objective
The aim of this study was to assess the dose-dependent antihypertensive efficacy and safety of perindopril 4 and 8 mg/day in the clinical setting.
Study Design and Setting
The CONFIDENCE study was a prospective, observational, multicenter trial. This was a real-world, clinic-based, outpatient study involving 880 general practitioners/primary-care clinics and 113 specialists in Canada.
Patients
The study included untreated or inadequately managed patients with hypertension (i.e. seated BP≥140/90 mmHg, or ≥130/80 mmHg in the presence of diabetes mellitus, renal disease, or proteinuria) without coronary artery disease (CAD).
Intervention
Treatment consisted of perindopril 4 mg/day, uptitrated to 8 mg/day as required for BP control at visit 2, for 12 weeks. Among the patients already being treated at baseline, perindopril either directly replaced all previous ACE inhibitors or angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]), or was added to antihypertensive treatment with calcium channel blockers (CCBs), diuretics, or β-adrenoceptor antagonists (β-blockers).
Main Outcomes Measures
The primary outcomes were the mean changes in BP from baseline following treatment with perindopril 4 and 8 mg/day as well as the proportion of patients achieving BP control (BP <140/90 mmHg, or <130/80 mmHg in diabetic patients) in the intent-to-treat (ITT) population. Secondary analyses included the incidence of adverse events and compliance.
Results
A total of 8298 hypertensive patients entered the study: 56% with newly diagnosed hypertension and 44% with uncontrolled hypertension. Mean SBP/DBP decreased significantly from baseline (152.5 ±10.8/89.5 ±9 mmHg) over 12 weeks (−18.5/−9.7 mmHg; p < 0.001). At visit 2, 23% of patients were uptitrated to perindopril 8 mg/day, which resulted in an additional mean 10.1/5.3 mmHg BP reduction; this reduction was even greater (15.1/5.7 mmHg) among a separate group of severely hypertensive patients (i.e. SBP >170 mmHg or DBP > 109 mmHg at baseline). Target BP was achieved in 54% of the ITT population. Both perindopril 4 mg/day and perindopril 8 mg/day were well tolerated and compliance was high throughout the study.
Conclusion
In the clinical outpatient setting, perindopril was found to be an effective dose-dependent and well tolerated antihypertensive treatment, with good compliance. Uptitration to the full therapeutic dosage of perindopril is an efficient approach for the management of a broad range of hypertensive patients without CAD.
Similar content being viewed by others
References
Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet 2005 Jan; 365: 217–23.
Wolf-Maier K, Cooper R, Kramer H, et al. Hypertension treatment and control in five European countries, Canada, and the United States. Hypertension 2004 Nov; 43: 10–7.
Oliveria SA, Lapuerta P, McCarthy BD, et al. Physician-related barriers to the effective management of uncontrolled hypertension. Arch Intern Med 2002 Feb; 162: 413–20.
Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003 Dec; 42(6): 1206–52.
Touyz RM, Canadian Hypertension Education Program (CHEP). Highlights and summary of the 2006 Canadian Hypertension Education Program recommendations. Can J Cardiol 2006 May; 22: 565–71.
Guo W, Turlapaty P, Shen Y, et al. Clinical experience with perindopril in patients nonresponsive to previous antihypertensive therapy: a large US community trial. Am J Ther 2004 May-Jun; 11: 199–205.
Julius S, Cohn JN, Neutel J, et al. Antihypertensive utility of perindopril in a large, general practice-based clinical trial. J Clin Hypertens (Greenwich) 2004 Jan; 6: 10–7.
Ogilvie RI, Anand S, Roy P, et al. Perindopril for control of blood pressure in patients with hypertension and other cardiovascular risk factors: an openlabel, observational, multicentre, general practice-based study. Clin Drug Investig 2008 Sep; 28: 673–86.
Poggi L, Renucci JF, Denolle T. Treatment of essential hypertension in general practice: an open-label study of 47,351 French hypertensive patients treated for one year with perindopril. Can J Cardiol 1994 Nov; 10 Suppl. D: 21D–4D.
Physicians’ Desk Reference. Montvale (NJ): Medical Economics Company, 2010.
Dahlof B, Sever PS, Poulter NR, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 2005 Sep; 366: 895–906.
Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358: 1887–98.
Patel A, MacMahon S, Chalmers J, et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007 Sep; 370: 829–40.
Bangalore S, Kumar S, Messerli F. Angiotensin-cnverting enzyme inhibitor associated cough: deceptive information from the Physicians’ Desk Reference. Am J Med 2010 Nov; 123: 1016–30.
Karpov I, Shal’nova SA, Deev AD. Prestarium in patients with arterial hypertension and ischemic heart disease (or risk factors): safe achievement of target blood pressure level (the PREMIERA study). Kardiologiia 2006; 46: 21–7.
Gasowski J, Wilkins A, Drzewoski J, et al. Short-term antihypertensive efficacy of perindopril according to clinical profile of 3,188 patients: a meta-analysis. Cardiol J 2010; 17: 259–66.
Johnston C, Fabris B, Yamada H, et al. Comparative studies of tissue inhibition by angiotensin converting enzyme inhibitors. J Hypertens 1989 Sep; 7: S11–6.
Bussien JP, d’Amore TF, Perret L, et al. Single and repeated dosing of the converting enzyme inhibitor perindopril to normal subjects. Clin Pharmacol Ther 1986 May; 39: 554–8.
Tropeano AI, Boutouyrie P, Pannier B, et al. Brachial pressure-independent reduction in carotid stiffness after long-term angiotensin-converting enzyme inhibition in diabetic hypertensives. Hypertension 2006 Jul; 48: 80–6.
Zhuo JL, Mendelsohn FA, Ohishi M. Perindopril alters vascular angiotensinconverting enzyme, AT(1) receptor, and nitric oxide synthase expression in patients with coronary heart disease. Hypertension 2002; 39: 634–8.
Ionescu DD. Antihypertensive efficacy of perindopril 5–10 mg/day in primary health care: an open-label, prospective, observational study. Clin Drug Investig 2009 Nov; 29: 767–76.
Telejko E. Perindopril arginine: benefits of a new salt of the ACE inhibitor perindopril. Curr Med Res Opin 2007 May; 23: 953–60.
Mourad JJ, Bertrand M. Impact of antihypertensive treatment on mortality: a late breaking analysis of recent trials in hypertension. J Hypertens 2010 Jun; 28 Suppl.: 37–495.
Vrijens B, Vincze G, Kristanto P, et al. Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories. BMJ 2008 May; 336: 1114–7.
Acknowledgments
The authors have received honoraria, research grants, or both, from Servier, Canada. The authors have no other relevant affiliations or financial involvement with any organization or entity in conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.
Furthermore, according to the rules and regulations of good clinical practice, none of the authors received any financial assistance for conducting this study, nor did they receive any monetary aid for the preparation of this manuscript.
Author information
Authors and Affiliations
Consortia
Rights and permissions
About this article
Cite this article
Tsoukas, G., Anand, S., Yang, K. et al. Dose-Dependent Antihypertensive Efficacy and Tolerability of Perindopril in a Large, Observational, 12-Week, General Practice-Based Study. Am J Cardiovasc Drugs 11, 45–55 (2011). https://doi.org/10.2165/11587000-000000000-00000
Published:
Issue Date:
DOI: https://doi.org/10.2165/11587000-000000000-00000