Adverse event with first-dose perindopril in congestive heart failure

Abstract

Ananalysis in 132 patients of factors thatmay predict a hypotensive response hasshown none that will be clinically useful(unpublished data). Together, suchfactors explain only 15% of thevariability in response;the choice of drugaccounts for an additional 10% of thevariability.We have consistently advised cautionwhen introducing ACE inhibitors in allpatients at high risk of hypotension—including those on higher doses of loopdiuretics, those with low pretreatmentblood pressure (<100 mm Hg systolic),and potentially unstable patients seenearly after an acute myocardial infarct.We continue to see a place for a drugsuch as perindopril even in these higherrisk circumstances as it is likely to keepthe first-dose effect to a minimum.