Abstract 5066: The Treatment Effect of Perindopril is Consistent in All Patients with Vascular Disease or High Risk of Vascular Disease: A Combined Analysis of Three Perindopril Trials

Abstract

The beneficial effect of the ACE-inhibitor perindopril has been demonstrated in large placebo-controlled clinical trials consisting of patients with stable CAD without overt heart failure (EUROPA), history of stroke (PROGRESS) and diabetes mellitus (ADVANCE). EUROPA investigated the effect of perindopril 8 mg during a mean follow-up of 4.2 years. PROGRESS investigated a perindopril 4mg/indapamide regimen during 4 years of follow-up and ADVANCE studied a perindopril 4 mg/indapamide regimen during 4.3 years of follow-up. In the three trials, mean blood pressure reduction was respectively, 5/2 mmHg, 9/4 mmHg and 6/2 mmHg. In all three trials, perindopril significantly reduced major cardiovascular events independent of baseline blood pressure levels. For this meta-analysis, we analyzed the treatment effect of the three trials combined on the shared endpoints of all-cause mortality and cardiovascular mortality & MI. Table 1 shows an analysis of three perindopril trials (EUROPA, PROGRESS and ADVANCE). When these findings were combined (n=29493), perindopril significantly reduced all-cause mortality (OR 0.89, 95% CI 0.82– 0.97), and cardiovascular mortality, MI (OR 0.82, 95% CI 0.74 – 0.90). This combined analysis shows that perindopril reduced cardiovascular events by 11–18% irrespective of risk level or the type of patients, which is in line with prior meta-analyses and risk models. This treatment benefit by perindopril is consistent among all patients with vascular disease or high risk of vascular disease. The treatment benefit by perindopril among patients with vascular disease or high-risk vascular disease.