242 Cardiovascular Benefits Of Perindopril In Coronary Artery Disease Patients With Hypertension. New Findings From The Europa Study According Jnc-7 Definition Of Hypertension

Abstract

In the EUROPA study, perindopril 8 mg/day significantly reduced the combined primary end point (PEP) of cardiovascular death, nonfatal myocardial infarction (MI), and/or resuscitated cardiac arrest by 20%, compared with placebo, after 4.2 years in 12 218 patients with stable coronary artery disease (CAD) without heart failure. The aim of this new analysis is to calculate the benefits of perindopril 8 mg/day in CAD patients with hypertension according to JNC-7 cutoff. In EUROPA, 7064 (57.8%) patients were hypertensive with SBP/DBP ≥ 140/90 mm Hg or current antihypertensive therapy. The baseline characteristics of these patients were not different from the whole EUROPA population: 63% had a previous MI (n=4469) and 54% were previously revascularized (n=3839). In EUROPA patients with hypertension, the incidence of the PEP with perindopril (n=3506) and placebo (n=3558) was 9% and 11.1%, respectively. The relative risk reduction (RRR) of PEP with perindopril was 18.6% (95% CI [6.9; 30.8]; P=0.004). Among EUROPA patients with hypertension, the RRR of fatal and nonfatal MI was 26.4% (95% CI [11.6; 38.8]; P=0.001), with a rate of 5.6% and 7.6% with perindopril and placebo, respectively. This reduction in risk for MI was consistent whether the patients had had previous MI (RRR, 32.6% [95% CI (16; 45.9); P<0.001]) or revascularization (RRR, 30.2%, [95% CI (7.7; 47.2); P=0.011]). Finally, heart failure was significantly reduced with perindopril (1.2%) versus placebo (2%) by 40.2% (95% CI [12.4; 59.2]; P=0.008). In these CAD patients with hypertension, discontinuation for hypotension was particularly low with perindopril (0.6%), similar to placebo (0.2%), confirming the safety of high-dose perindopril (8 mg/day) in terms of BP lowering. In the EUROPA study, the benefit with perindopril 8 mg/day was consistent among hypertensive CAD patients, even in case of previous MI and/or revascularization. These results are in line with the 2006 ESC guidelines on the management of stable angina pectoris, endorsing the use of this dose of perindopril, which is of proven efficacy in this indication (Class 1, level of evidence A)