Treatment with angiotensin-converting enzyme inhibitors: insight into perindopril cardiovascular protection

Abstract

Angiotensin-converting enzyme (ACE) inhibitors have an established role in the treatment of patients across the cardiovascular disease continuum, from uncomplicated hypertension to established cardiovascular disease. The first data showing the efficacy of ACE inhibitors for the prevention of cardiovascular events came from the Heart Outcomes Prevention Evaluation trial with ramipril. Since then a number of other large, randomized, controlled trials have confirmed the beneficial effects of ACE inhibitors on cardiovascular outcomes in a variety of patient groups. In addition, evidence suggests that these beneficial effects of ACE inhibitors occur independently of their blood pressure (BP)-lowering effects, a phenomenon that has not been observed for angiotensin receptor blockers. Among the ACE inhibitors, perindopril has the greatest body of evidence for cardiovascular preventive efficacy from major morbidity–mortality trials (e.g. ADVANCE, ASCOT-BPLA, EUROPA, PREAMI, PEP-CHF, PROGRESS). In addition, perindopril may be the treatment of choice in stable coronary artery disease because of its unique anti-apoptotic activity and protective effects on the endothelium. A current major trend in cardiovascular medicine is the increased use of combination therapies. The data reviewed here suggest that any combination therapy for secondary prevention across the continuum of cardiovascular disease should contain an ACE inhibitor.