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Antihypertensive Efficacy of Perindopril 5–10 mg/day in Primary Health Care

An Open-Label, Prospective, Observational Study

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Abstract

Background and Objectives: Optimal control of hypertension reduces the risk of long-term cardiovascular complications, and current guidelines recommend blood pressure (BP) targets of <140/90 mmHg for patients. Despite this, the BP of many patients with hypertension in primary health care remains poorly controlled. The ACE inhibitor perindopril has proven BP-lowering efficacy as well as protective effects against cardiovascular events among patients with additional cardiovascular risk factors. The PREFER study assessed the anti-hypertensive efficacy and safety of perindopril 5–10 mg/day among hypertensive patients who were unresponsive to treatment with other ACE-inhibitor-based regimens.

Methods: The PREFER study was an open-label, prospective, observational study conducted in primary health-care centres throughout Romania. Patients selected for the study (n = 824; mean ± SD age 60.3 ± 9.8 years) had uncontrolled hypertension (i.e. seated BP >−140/90 mmHg, or >−130/80 mmHg in patients with diabetes mellitus or at high cardiovascular risk) despite receiving ACE inhibitors either alone or in free combination with other antihypertensive classes. At study entry, current ACE inhibitor treatment was replaced by perindopril 5 mg/day. Patients were followed up monthly for 3 months and the dosage of perindopril could be increased to 10 mg/day in cases of failure to achieve BP control. No other change in antihypertensive therapy was permitted.

Results: Replacing the previous ACE inhibitor with perindopril 5–10 mg/day resulted in decreases of 26.2mmHg (from 162.6 ±15.6 to 136.4 ±14.6 mmHg [p < 0.001]) in systolic BP and of 12.6 mmHg (from 96.9 ±17.2 to 84.3 ±12.8 mmHg [p<0.001]) in diastolic BP. Mean pulse pressure (PP) was reduced by 13.6 mmHg (from 65.7 to 52.1 mmHg) with greater decreases seen in patients aged >70 years or with isolated systolic hypertension. BP control was achieved in 48.1% of the previously uncontrolled population. Antihypertensive efficacy was observed across patient subgroups regardless of the severity of hypertension at baseline and number of cardiovascular risk factors. Patient compliance with treatment was high throughout the study.

Conclusions: Perindopril 5–10 mg/day lowers BP and PP and improves BP control among hypertensive patients who were previously unresponsive to other ACE inhibitor-based regimens.

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References

  1. Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2007; 28: 1462–536

    PubMed  Google Scholar 

  2. Mancia G, Sega R, Milesi C, et al. Blood-pressure control in the hypertensive population. Lancet 1997; 349: 454–7

    Article  PubMed  CAS  Google Scholar 

  3. Oliveria SA, Lapuerta P, McCarthy BD, et al. Physician-related barriers to the effective management of uncontrolled hypertension. Arch Intern Med 2002; 162: 413–20

    Article  PubMed  Google Scholar 

  4. Falaschetti E, Chaudhury M, Mindell J, et al. Continued improvement in hypertension management in England: results from the Health Survey for England 2006. Hypertension 2009; 53: 480–6

    Article  PubMed  CAS  Google Scholar 

  5. 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; 42: 1206–52

    Article  PubMed  CAS  Google Scholar 

  6. Khan NA, Hemmelgarn B, Herman RJ, et al. The 2009 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2. Therapy. Can J Cardiol 2009; 25: 287–98

    Article  PubMed  Google Scholar 

  7. Guo W, Turlapaty P, Shen Y, et al. Clinical experience with perindopril in patients nonresponsive to previous anti-hypertensive therapy: a large US community trial. Am J Ther 2004; 11: 199–205

    Article  PubMed  Google Scholar 

  8. 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; 6: 10–7

    Article  CAS  Google Scholar 

  9. Ogilvie RI, Anand S, Roy P, et al. Perindopril for control of blood pressure in patients with hypertension and other cardiovascular risk factors: an open-label, observational, multicentre, general practice-based study. Clin Drug Investig 2008; 28: 673–86

    Article  PubMed  CAS  Google Scholar 

  10. 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; 10Suppl. D: 21D–4D

    PubMed  Google Scholar 

  11. Cleland JG, Tendera M, Adamus J, et al. The Perindopril in Elderly People with Chronic Heart Failure (PEP-CHF) study. Eur Heart J 2006; 27: 2338–45

    Article  PubMed  CAS  Google Scholar 

  12. 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; 366: 895–906

    Article  PubMed  Google Scholar 

  13. Ferrari R. Effects of angiotensin-converting enzyme inhibition with perindopril on left ventricular remodeling and clinical outcome: results of the randomized Perindopril and Remodeling in Elderly with Acute Myocardial Infarction (PREAMI) Study. Arch Intern Med 2006; 166: 659–66

    Article  PubMed  CAS  Google Scholar 

  14. Fox KM. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 2003; 362: 782–8

    Article  PubMed  CAS  Google Scholar 

  15. PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet 2001; 358: 1033–41

    Article  Google Scholar 

  16. Telejko E. Perindopril arginine: benefits of a new salt of the ACE inhibitor perindopril. Curr Med Res Opin 2007; 23: 953–60

    Article  PubMed  CAS  Google Scholar 

  17. Yusoff K, Razak TA, Yusof N, et al. Comparative efficacy of perindopril and enalapril once daily using 24-hour ambulatory blood pressure monitoring. Int J Clin Pract 1999; 53: 277–80

    PubMed  CAS  Google Scholar 

  18. Zhuo JL, Mendelsohn FAO, Ohishi M. Perindopril alters vascular angiotensin-converting enzyme, AT1 receptor, and nitric oxide synthase expression in patients with coronary heart disease. Hypertension 2002; 39: 634–8

    Article  PubMed  CAS  Google Scholar 

  19. 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

    PubMed  Google Scholar 

  20. Blacher J, Staessen JA, Girerd X, et al. Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients. Arch Intern Med 2000; 160: 1085–9

    Article  PubMed  CAS  Google Scholar 

  21. Brugts JJ, Ninomiya T, Boersma E, et al. The consistency of the treatment effect of an ACE-inhibitor based treatment regimen in patients with vascular disease or high risk of vascular disease: a combined analysis of individual data of ADVANCE, EUROPA, and PROGRESS trials. Eur Heart J 2009; 30: 1385–94

    Article  PubMed  CAS  Google Scholar 

  22. 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; 370: 829–40

    Article  PubMed  CAS  Google Scholar 

  23. Bots ML, Remme WJ, Luscher TF, et al. ACE inhibition and endothelial function: main findings of PERFECT, a sub-study of the EUROPA Trial. Cardiovasc Drugs Ther 2007; 21: 269–79

    Article  PubMed  CAS  Google Scholar 

  24. Ceconi C, Fox KM, Remme WJ, et al. ACE inhibition with perindopril and endothelial dysfunction: results of a sub-study of the EUROPA study — PERTINENT. Cardiovasc Res2007; 73: 237–46

    Article  PubMed  CAS  Google Scholar 

  25. Ferrari R, Pasanisi G, Notarstefano P, et al. Specific properties and effect of perindopril in controlling the reninangiotensin system. Am J Hypertens 2005; 18: 142S–54S

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

This study was financially supported by Servier. The author has received honoraria from Servier but has no other relevant affiliations, financial involvements with any organization or entity, or conflicts of interest that are directly relevant to the content of this study.

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  1. Craiova Cardiology Centre, 1 Tabaci Street, Craiova, 200642, Romania

    Dan-Dominic Ionescu

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Ionescu, DD., PREFER Investigators. Antihypertensive Efficacy of Perindopril 5–10 mg/day in Primary Health Care. Clin. Drug Investig. 29, 767–776 (2009). https://doi.org/10.2165/11319700-000000000-00000

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  • DOI: https://doi.org/10.2165/11319700-000000000-00000

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