Our objective was to evaluate a triple-drug antihypertensive strategy for blood pressure control in patients with difficult-to-treat hypertension.
The Perindopril-Indapamide plus AmlodipiNe in high rISk hyperTensive patients (PIANIST) trial was an observational, 4-month, open-label study.
Patients and interventions
A total of 4,731 patients at high or very high cardiovascular risk with hypertension that was not properly controlled despite antihypertensive therapy, and for whom study treatment (fixed-dose perindopril 10 mg/indapamide 2.5 mg + amlodipine 5 or 10 mg) was consistent with their existing therapeutic plan, were included.
One-sample t tests and Chi-squared tests were performed to evaluate changes in blood pressure.
Mean baseline office blood pressure (OBP) was 160.5 ± 13.3/93.8 ± 8.7 mmHg. After 4 months of therapy, OBP decreased by 28.3 ± 13.5/13.8 ± 9.4 to 132.2 ± 8.6/80.0 ± 6.6 mmHg (p < 0.0001). Blood pressure targets were reached by 72.0 % of patients and by 81 and 91 % of patients previously treated with an angiotensin-converting enzyme inhibitor/hydrochlorothiazide or an angiotensin receptor blocker/hydrochlorothiazide, respectively. Changes in OBP were 18.7 ± 8.3/9.7 ± 7.2 mmHg for grade 1 (n = 1,679), 30.4 ± 10.1/14.7 ± 8.6 mmHg for grade 2 (n = 2,397), and 45.4 ± 15.1/20.7 ± 12.1 mmHg for grade 3 patients (n = 655; all p < 0.0001). In patients who underwent ambulatory blood pressure monitoring (n = 104), 24-h mean blood pressure decreased from 147.4 ± 13.8/82.1 ± 11.9 to 122.6 ± 9.1/72.8 ± 7.4 mmHg (p < 0.0001). Ankle edema was infrequent (0.2 % of patients).
Triple combination perindopril/indapamide/amlodipine was effectively and safely administered to a large population of high- and very high-risk hypertensive patients who had not reached target OBP values with previous treatment.
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The author would like to thank Hélène Dassule, PhD, for her editorial support. Her work was funded by Servier International. This study was funded by Egis Pharmaceuticals, Budapest, Hungary. The author has no other potential conflicts of interest that might be relevant to the contents of this manuscript. The author acknowledges the contribution of all 762 participating medical centers in Hungary. In addition to the other members of the PIANIST investigator group, the author would like to acknowledge the assistance of Béla Malomvölgyi (medical advisor) and Norbert Habony, MD (coordinator).
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Tóth, K., on behalf of PIANIST Investigators. Antihypertensive Efficacy of Triple Combination Perindopril/Indapamide Plus Amlodipine in High-Risk Hypertensives: Results of the PIANIST Study (Perindopril-Indapamide plus AmlodipiNe in high rISk hyperTensive patients). Am J Cardiovasc Drugs 14, 137–145 (2014). https://doi.org/10.1007/s40256-014-0067-2