Effect of perindopril erbumine, an angiotensin converting enzyme inhibitor (ACE-I), in the treatment of 1022 African-American patients with mild to moderate hypertension: subgroup analysis of a 12 week, open-label, Aceon®Community Trial (ACT)

Abstract

There is an ongoing controversy regarding the efficacy of ACE-I in the African-American (AA) population. In this study, the efficacy and safety of perindopril erbumine on sitting blood pressure (BP) were analyzed in a subset of AA patients (n=1022), from a 12 Week, open-label, community study. All patients were treated with perindopril 4 mg QD for 6 weeks. Based on the BP response, dose was maintained on perindopril 4 mg or increased to perindopril 8 mg QD for an additional 6 weeks. BP was measured at Baseline (antihypertensives withdrawn), Week 6, and Week 12. Treatment with perindopril (4 to 8 mg QD) for 12 weeks produced a clinically significant reduction in systolic (SBP) and diastolic (DBP) blood pressure. In AA patients with inadequate response at Week 6 (Group 2), increase in perindopril dose to 8 mg QD produced additional decrease in SBP and DBP, supporting the titration approach. At Week 12, BP control with perindopril defined as SBP/DBP <140/90 mmHg, SBP <140 mmHg or DBP <90 mmHg, SBP <140 mmHg, and DBP <90 mmHg was achieved in 38%, 69%, 48%, and 59%; respectively. Based on JNC VI classification (systolic/diastolic), an increase in shift of patients from Baseline to Week 12 in nonhypertensive BP categories was: Optimal 1%/3% to 6%/18%; Normal 3%/4% to 14%/24%; and High-Normal 6%/7% to 29%/18%. Additionally, treatment with perindopril controlled BP in a significant number of AA patients who were uncontrolled on previous ACE-I therapy. The antihypertensive effect of perindopril was well maintained throughout the 12 week period. Adverse events were reported in 19% of the patients, of which 1.3% were serious. Cough and angioedema were reported in 5% and 0.9%, respectively. Collectively, these results suggest that a large proportion of AA patients with hypertension can be successfully controlled with perindopril as monotherapy. As shown in Group 2, these data also lend credence for a titration approach in the control of BP in patients with an inadequate response at low dose of perindopril that is well tolerated in this population. (See Table) Group 1=Patients on perindopril 4 mg at Weeks 1-12; Group 2=Patients on perindopril 4 mg at Weeks 1-6 and perindopril 8 mg at Weeks 7-12; p<0.001; SBP/DBP; Values are expressed as mean ±SEM Group 1=Patients on perindopril 4 mg at Weeks 1-12; Group 2=Patients on perindopril 4 mg at Weeks 1-6 and perindopril 8 mg at Weeks 7-12; p<0.001; SBP/DBP; Values are expressed as mean ±SEM