Perindopril In Patients Research Articles

The Effectiveness and Tolerability of Switching Patients from Sacubitril/Valsartan, ARNI to Perindopril in Heart Failure with Reduced Ejection Fraction: EFFICIENT Trial

Objectives Heart failure with reduced ejection fraction (HFrEF) is an advancing illness that can be managed with various drugs. In this study, we present data on the tolerance of perindopril in patients with HFrEF who were switched from angiotensin receptor neprilysin inhibitor (ARNI) to perindopril because of issues with the former’s tolerability or increased medication costs. Methods A total of 125 patients with HFrEF were switched to perindopril in this retrospective study carried out at the heart failure clinic. Of those, 109 patients had data accessible for a 6-month follow-up. The data of the patients who switched from ARNI to perindopril between June and December 2023 were collected. Data such as the New York Heart Association (NYHA) class, N-terminal pro hormone brain natriuretic peptide (NT-proBNP), and left ventricular ejection fraction (LVEF) were compared at baseline and 6-month follow- up with those collected after the switchover. Results During the transition, the average age was 58 ± 13 years (mean ± standard deviation), the disease duration was 2.6 ± 1.4 years, and 29.6% of the patients were female. The average period of follow-up following the transition was 5.7 ± 1.5 months. The 6-minute walk distance (6MWD) reduced from 344 ± 106 to 319 ± 85 m ( P = .056), but the NT-pro BNP levels increased from 478 ± 170 to 490 ± 137 pg/mL ( P = .56) after the transfer. All patients continued to maintain their NYHA functional class after the transition, with no significant difference seen ( P = .37). There was a little improvement in LVEF from 40% ± 4% to 41.5% ± 5% ( P < .001) during the follow-up after the switchover. Following the transition, no changes were observed in vital indicators, serum electrolytes, and creatinine levels. All patients successfully tolerated the transition to perindopril. Conclusions The transfer from ARNI to perindopril was both well tolerated and safe. The patients’ functional condition remained unchanged, as did their NT-pro BNP levels. A modest improvement in LVEF was noted. In India, switching from ARNI to perindopril is less expensive.

Preliminary Consequences of Blood Pressure Management and Blood Homocysteine Levels with Perindopril in Newly Diagnosed Hypertensive Patients in the Vietnamese Population.

Perindopril is an ACE inhibitor that aids in both blood pressure regulation and homocysteine reduction. Our study aimed to evaluate the results of controlling blood pressure and blood homocysteine levels by perindopril in patients with primary hypertension. A cross-sectional descriptive study with a longitudinal follow-up was conducted on 105 primary hypertensive patients treated with perindopril. The results of our study showed that after 6 weeks of treatment with perindopril, the proportion of patients with the target blood pressure (BP) level accounted for 70.5%, the rate of grade 1 hypertension decreased from 61.0% to 25.7%, grade 2 blood pressure decreased from 17.1% to 3.8%, and there was no case of grade 3 hypertension. At the same time, we also found that the rate of BP control in the group of patients who controlled Hcy below a threshold of 15 μmol/L was significantly higher than in the other group (p < 0.05). Concerning the efficacy of decreasing homocysteine in blood, we discovered that after 6 weeks of treatment with perindopril, the proportion of patients with elevated homocysteine reduced considerably from 74.3% to 40% (p < 0.05). In addition, the homocysteine concentration was 4.33 mol/L lower after treatment than before treatment (95% CI: 3.69-4.97) (p < 0.05). Perindopril helps control blood pressure and reduces blood homocysteine levels in patients with primary hypertension.

Antihypertensive effect of telmisartan versus perindopril in hypertensive patients.

We performed this meta-analysis determining the antihypertensive effect of telmisartan versus perindopril in patients with essentialhypertension. The comparison of antihypertensive effects between telmisartan and perindopril were controversial. Pubmed, Web of Science, and Cochrane Central were searched for all published studies. The antihypertensive effects were assessed in 753 patients included in 7 trials with a mean follow-up of 20 ± 16 weeks. There was no significant difference between telmisartan and perindopril in reduction of systolic blood pressure (SBP, weighted mean differences (WMD) 0.02 (95% confidence interval (CI), ‒2.78, 2.81) mm Hg, p > 0.05). The reduction of diastolic BP (DBP) treated with telmisartan was greater than perindopril in these patients (WMD ‒2.05 (95% CI, ‒2.60, ‒1.49) mm Hg, p < 0.001). Considering the effects of different doses on BP reduction, a sub-analysis was performed. The reduction of DBP treated with 40 mg/day telmisartan was greater than 4‒5 mg/day perindopril (WMD ‒2.18 (95% CI, ‒2.83, ‒1.53) mm Hg, p 0.05). The reduction of DBP is greater treated with telmisartan than perindopril in patients with essentialhypertension (Tab. 2, Fig. 4, Ref. 34). Text in PDF www.elis.sk Keywords: essential hypertension, blood pressure, telmisartan, perindopril, meta-analysis.

Ефективність фіксованої подвійної комбінації бісопрололу і периндоприлу в пацієнтів зі стабільною ішемічною хворобою серця та артеріальною гіпертензією різного ступеня

The aim – to evaluate the hypotensive and antianginal efficacy of a fixed double combination (bisoprolol, perindopril) in patients with coronary artery disease (CAD) and concomitant hypertension.Materials and methods. The study involved 170 cardiologists from various regions of Ukraine. Each researcher selected 15 consecutive outpatients with coronary heart disease who came for a regular visit. Inclusion criteria: age over 18 years old, blood pressure (BP) above 140/90 mm Hg, heart rate (HR) above 60 bpm, bisoprolol as part of antihypertensive therapy in the last ≥ 3 months. The study included two visits. At each visit, the patient’s objective status was assessed; an individual questionnaire with office systolic and diastolic blood pressure, heart rate, ECG data, clinical manifestations of CAD, risk factors, lifestyle features, concomitant diseases, current therapy was filled out. Medication adherence was also evaluated, the therapy was corrected if necessary and the presence of side effects and adverse events was registered. We analyzed the levels of BP and HR at the beginning and at the end of the study, the percentage of achievement of the recommended levels of these indicators, the antianginal efficacy of treatment and adherence to therapy in patients with CAD and different degrees of hypertension after 4 weeks of treatment.Results and discussion. 2785 patient questionnaires were provided by doctors, 1747 patients were included in substudy. The mean age of the patients was 60.9±10.2 years old, men – 57.1 %, women – 42.9 %. The diagnosis of coronary artery disease was based on: chest pain – 554 (31.7 %), a history of documented myocardial infarction – 935 (53.5 %), coronary ventriculography – 536 (30.7 %), revascularization (CABG/stenting) – 344 (19.8 %) patients. The use of a fixed combination of previously taken drugs (perindopril, bisoprolol) for 4 weeks allows to reduce heart rate and blood pressure effectively (HR ≤ 70 bpm reached 84.9 % of patients, BP ≤ 140/90 mm Hg – 86.9 %), to reduce the number of angina attacks (from 4.48, 4.5 and 4.7 per week at the beginning of the study to 2.4; 2.9 and 2.3 per week in patients with 1, 2 and 3 degrees of hypertension, respectively) and the need for nitroglycerin from from 4.5; 4.9 and 5.9 tab per week up to 2.4; 2.9 and 2.3 tab per week. The most significant absolute decrease of BP and HR was in patients with a more severe degree of hypertension (decrease systolic BP was – 40.8 mm Hg, diastolic BP – 21.4 mm Hg, HR – 21.8 bpm).Conclusions. The study demonstrated that the use of the fixed combination of bisoprolol and perindopril in patients with coronary artery disease and concomitant hypertension (different degrees) helps to improve treatment efficacy, to achieve recommended levels of blood pressure and heart rate, also has a significant antianginal effect (reliable decrease of the number of angina attacks and the need to take nitroglycerin) and increases adherence to therapy.

Effectiveness and Tolerability of the Single-Pill Combination of Bisoprolol and Perindopril in Patients with Arterial Hypertension and Stable Coronary Artery Disease in Daily Clinical Practice: The STYLE Study.

IntroductionCombination antihypertensive therapy is required by most patients to achieve guideline-recommended blood pressure (BP) goals. This study assessed the effectiveness and tolerability of bisoprolol/perindopril (Bis/Per) single-pill combination (SPC) in Russian patients with hypertension and coronary artery disease (CAD) treated in routine clinical practice.MethodsSTYLE (NCT03730116) was an open-label, uncontrolled, prospective observational study conducted in patients who were already receiving Bis/Per SPC, switched to SPC from Bis or Per monotherapy, or switched from a free combination of Bis and Per. Primary endpoint criteria were assessed at 1 and 3 months and included change in mean office systolic/diastolic blood pressure (SBP/DBP), proportion achieving target BP (< 140/90 mmHg), and measures of antianginal effectiveness.ResultsThe full analysis set comprised 1892 subjects. Mean age was 61.9 ± 8.8 years, 53.2% were women, and mean durations of hypertension and CAD were 12.5 ± 7.9 and 7.2 ± 6.4 years, respectively. Mean SBP/DBP decreased by 22.3/11.0 mmHg and 31.5/15.9 mmHg at 1 and 3 months, respectively (P < 0.0001 vs baseline). Target BP was achieved by 49.2% and 86.7% of patients at 1 and 3 months, respectively. Reductions in mean number of angina attacks and nitrate consumption and improvements in heart rate were statistically significant. Treatment was well tolerated.ConclusionTreatment of patients with hypertension and CAD with Bis/Per SPC for 3 months was associated with significant decreases in SBP/DBP and a high proportion of patients achieving BP treatment goals. This was accompanied by an improvement in angina symptoms. Treatment was well tolerated in a broad patient population representative of those seen in everyday clinical practice.Infographic

Cost-Effectiveness of Cardiovascular Magnetic Resonance in Diagnosing Coronary Artery Disease in the Australian Health Care System

Coronary artery disease (CAD) remains a major public health problem in Australia and globally. A variety of imaging techniques allow for both anatomical and functional assessment of CAD and selection of the optimal investigation pathway is challenging. Cardiovascular magnetic resonance (CMR) is not widely used in Australia, partly due to perceived cost and lack of Federal Government reimbursement compared to the alternative techniques. The aim of this study was to estimate the cost-effectiveness of different diagnostic strategies in identifying significant CAD in patients with chest pain suggestive of angina using the evidence gathered in the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 (CE-MARC trial), analysed from the Australian health care perspective. A decision analytic model coupled with three distinct Markov models allowed eight potential clinical investigation strategies to be considered; combinations of exercise electrocardiogram stress testing (EST), single-photon emission computed tomography (SPECT), stress CMR, and invasive coronary angiography (ICA). Costs were from the Australian health care system in Australian dollars, and outcomes were measured in terms of quality-adjusted life-years. Parameter estimates were derived from the CE-MARC and EUropean trial on Reduction Of cardiac events with Perindopril in patients with stable coronary Artery disease (EUROPA) trials, and from reviews of the published literature. The most cost-effective diagnostic strategy, based on a cost-effectiveness threshold of $45,000 to $75,000 per QALY gained, was EST, followed by stress CMR if the EST was positive or inconclusive, followed by ICA if the stress CMR was positive or inconclusive; this held true in the base case and the majority of scenario analyses. This economic evaluation shows that an investigative strategy of stress CMR if EST is inconclusive or positive is the most cost-effective approach for diagnosing significant coronary disease in chest pain patients within the Australian health care system.

Efficacy and Safety of Perindopril in Patients with Essential Hypertension

Introduction:Perindopril is a tissue-specific ACE inhibitor with 24 hours long blood pressure-lowering effect, which protects blood vessels and decreases the variability of blood pressure.Aim:The aim of our study was to investigate the effectiveness and safety of perindopril in newly diagnosed or previously treated but uncontrolled adult hypertensive patients.Methods:This prospective cohort study included primary care patients with essential hypertension. Primary study outcomes were decreasing arterial blood pressure to normal levels (<140/90 mmHg), reducing systolic arterial blood pressure for 10 mmHg or more and reducing diastolic arterial blood pressure for 5 mmHg or more. Safety was evaluated by type and frequency of adverse events.Results:In the great majority of the study patients (more than 96%) perindopril was effective as monotherapy, achieving a significant reduction in both systolic and diastolic blood pressure, and in three-quarters of the study patients it normalized both systolic and diastolic blood pressure. The effectiveness of perindopril was shown in both patients with previously and newly diagnosed hypertension, adverse events were mild and rare, even hyperkalemia was encountered less often than before the onset of the therapy with perindopril.Conclusions:Our study confirmed excellent effectiveness of perindopril in the treatment of essential hypertension and its remarkable safety. When used as monotherapy of hypertension, perindopril’s doses should be carefully titrated until the achievement of full effect, which in some patients should be awaited for at least 6 months from onset of the therapy.

The effectiveness of treatment of patients with stable coronary heart disease and concomitant arterial hypertension: the results of a multicenter study PRESTOL

The aim – to evaluate the profile of patients with coronary heart disease (CHD) and concomitant arterial hypertension (AH) who were administered bisoprolol as part of previous therapy, but did not reach normal levels of heart rate and blood pressure; to estimate the percentage of getting to recommended levels of heart rate, blood pressure and treatment adherence in patients after 4 weeks of using the fixed-dose combination of bisoprolol/perindopril with a correction of doses.Materials and methods. The study involved 170 cardiologists from various regions of Ukraine. Each researcher selected 15 consecutive outpatients with coronary heart disease who came for a regular visit. Inclusion criteria: age over 18 years old, blood pressure above 140/90 mm Hg, heart rate above 60 bpm, bisoprolol as part of antihypertensive therapy in the last ≥ 3 months. The study included two visits. At each visit, the patient’s objective status was assessed; an individual questionnaire with office systolic and diastolic blood pressure, heart rate, ECG data, clinical manifestations of CHD, risk factors, lifestyle features, concomitant diseases, current therapy was filled out. Medication adherence was also evaluated, the therapy was corrected if necessary and the presence of side effects and adverse events was registered.Results and discussion. 2785 patient questionnaires were provided by doctors, 2394 (86 %) of them met the inclusion criteria. The mean age of the patients was 61.4 years, men – 57.1 %, women – 42.9 %. The diagnosis of coronary artery disease was based on: chest pain – 751 (31.7 %), a history of documented myocardial infarction – 1281 (53.5 %), coronary ventriculography (VHR) – 735 (30.7 %), revascularization (CABG/stenting) – 474 (19.8 %) patients. The use of a fixed combination of previously taken drugs (perindopril, bisoprolol) for 4 weeks allows to reduce heart rate and blood pressure effectively (heart rate ≤ 70 bpm reached 84.9 % of patients, blood pressure ≤ 140/90 mm Hg – 86.9 %), to reduce the number of angina attacks from 4.4 to 2.6 per week and the need for nitroglycerin from 4.8 to 2.7 tablets per week, to improve therapy adherence in 66.5 % of patients.Conclusions. The study demonstrated that the use of the fixed combination of bisoprolol and perindopril in patients with coronary artery disease and concomitant hypertension, including those who had myocardial revascularization and myocardial infarction in anamnesis, helps to improve treatment efficacy, to achieve recommended levels of blood pressure and heart rate, to increase adherence to therapy.

Effectiveness of Dispersible Forms of Perindipril in Patients With Uncontrolled Arterial Hypertension in Clinical Practice

The study was aimed at evaluating the efficacy and usability of a dispersible form of perindopril in patients with arterial hypertension (HT) in clinical practice. The study enrolled 52 patients with newly diagnosed or uncontrolled HT of grade 1-2. The baseline assessment consisted of physical examination, instrumental and laboratory tests, including electrocardiography, clinical and biochemical blood tests, measurement of daily albuminuria, and estimation of glomerular filtration rate (GFR). The assessment was repeated at 12 weeks of treatment. The patients were asked to complete questionnaires at the first visit, in order to determine the potential need for administration of dispersible tablets, and at the last visit, to evaluate the convenience of their use. Depending on the baseline blood pressure (BP) and the risk for cardiovascular events, patients were treated with perindopril dispersible form 10 mg/daily in monotherapy, or with combination of perindopril 10 mg/daily in the dispersible form and indapamide retard 1.5 mg/daily. The interim assessments of the treatment efficacy and safety were carried out at 2 and 4 weeks, and the final assessment was performed at 12 weeks from inclusion. The target BP was achieved in 22 (42.3%) patients at 2 weeks, 35 (67.3%) patients at 4 weeks, and 50 (96.2%) patients at 12 weeks of treatment. The reductions in systolic and diastolic BP, assessed by office BP measurements and BP self-control, as well as reduction in heart rate became significant (<0.001) as earlier as after 2 weeks of treatment, and this trend continued up to 12 weeks. In addition, the treatment was associated with by a significant reduction in daily albuminuria, serum creatinine, and increase in GFR. According to the survey data, 71.4% of patients preferred dispersible form of perindopril to the ordinary one, considering it as more convenient, effective and applicable in various everyday situations. In patients with HT, the dispersible form of perindopril in monotherapy and in combination with a diuretic provides a rapid and substantial BP reduction, as well as the achievement of target BP values in the majority of cases. In addition, such a treatment is associated with a significant positive effect on the heart rate, as well as on the renal function. Treatment with a soluble form of perindopril is well tolerated by patients and is estimated by them as a convenient and effective one.

Эффективность оригинального периндоприла у пациентов с артериальной гипертензией: результаты региональной программы «ПРИЗНАНИЕ»

Эффективность оригинального периндоприла у пациентов с артериальной гипертензией: результаты региональной программы «ПРИЗНАНИЕ»

Treatment with perindopril in patients with arterial hypertension: improving compliance

The problem of the compliance is relevant in the treatment of patients with arterial hypertension. The review presents the data to identify mechanisms for improving the compliance in the context of one of the most studied drugs, such as - perindopril. We have indicated the aspects of perindopril monotherapy, as well as in combination with indapamide and amlodipine. We have showed the advantages of fixed combinations. The individual aspect of the easy medicine administration isdispersion form of the drug. This article shows the advantages of usage PrestariumR ORO - innovative form of perindopril, mouth dissolving tablets.

Периндоприл в терапии артериальной гипертензии: повышаем комплаенс Г.С.

Периндоприл в терапии артериальной гипертензии: повышаем комплаенс Г.С.

Prediction of absolute risk reduction of cardiovascular events with perindopril for individual patients with stable coronary artery disease — Results from EUROPA

BackgroundAngiotensin-converting-enzyme inhibition reduces the risk of cardiovascular events at a group level. Presumably, the absolute effect of treatment varies between individuals. We sought to develop multivariable prediction scores to estimate individual treatment effect of perindopril in patients with stable coronary artery disease (sCAD). MethodsIn EUROPA trial participants, we estimated the individual patient 5-year absolute risk reduction (ARR) of major adverse cardiovascular events(MACE) by perindopril. Predictions were based on a new Coxproportional-hazards model with clinical characteristics and an external risk score in combination with the observed relative risk reduction. Second, a genetic profile modifying the relative efficacy of perindopril was added. The individual patient ARR was defined as the difference in MACE risk with and without treatment. The group level impact of selectively treating patients with the largest predicted treatment effect was evaluated using net benefit analysis. ResultsThe risk score combining clinical and genetic characteristics estimated the 5-year absolute treatment effect to be absent or adverse in 27% of patients. On the other hand, the risk score estimated a small 5-year ARR of ≤2% (NNT5≥50) in 20% of patients, a modest ARR of 2–4% (NNT5 25–50) in 26%, and a large ARR of ≥4% (NNT5≤25) in 28%. The external risk score yielded similar predictions. Selective prediction-based treatment resulted in higher net benefit compared to treat everyone at any treatment threshold. ConclusionA prediction score combining clinical characteristics and genetic information can quantify the ARR of MACE by perindopril for individual patients with sCAD and may be used to guide treatment decisions. Trial registration numberISRCTN37166280

Aliskiren attenuates oxidative stress and improves tubular status in non-diabetic patients with chronic kidney disease-Placebo controlled, randomized, cross-over study

PurposePharmacological inhibition of the renin-angiotensin-aldosteron system (RAAS) may have a beneficial impact on proteinuria and chronic kidney diseases (CKD) progression. Despite recent progress by means of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB), there is still no optimal therapy which can stop progression of the nephropathy. Recently introduced aliskiren is the first orally bioavailable direct renin inhibitor approved for the treatment of hypertension. The purpose was to evaluate the extent of oxidative stress and tubular injury after the direct renin inhibitor, aliskiren compared with placebo and perindopril in patients with non-diabetic chronic kidney disease (NDCKD). Material/methodsA randomized, double-blind, cross-over trial was performed in 14 patients receiving 300mg aliskiren, 10mg perindopril and placebo in random order. The end point was a change in the urinary excretion of N-acetyl-β-D-glucosaminidase (NAG) and α1-microglobulin (α1m) and 15-F2α-isoprostane. ResultsAliskiren reduced excretion of 15-F2α-isoprostane (p=0.03) and α1m (p=0.01) as compared to placebo. There were no differences between aliskiren and perindopril in this regard. NAG urine excretion did not change after aliskiren and perindopril. ConclusionsAliskiren attenuates oxidative stress and may improve functional status of tubules in patients with NDCKD.

Research on the intervention effect of serum pro-bnp of bisoprolol combined with perindopril in patients with chronic heart failure

Objective To investigate the intervention effect of serum pro-bnp of bisoprolol combined with perindopril in patients with chronic heart failure Methods 120 cases with chronic heart failure of our hospital were randomly divided into 3 groups, bisoprolol group, perindopril group and bisoprolol combined with perindopril group, 40 cases for each group, the serum pro-bnp was determined before and after treatment, observed the curative effect.Results The total effective rate of combined treatment group was 95.0%, that was better than the bisoprolol group (80.0%) and perindopril group (77.5%),P＜0.05 ,after treatment, the level of serum pro-bnp of combined treatment group was less than that of bisoprolol group and perindopril group, P＜0.05.Conclusion bisoprolol combined with perindopril can decrease the level of serum pro-bnp significantly, the curative effect is exact. Key words: Chronic heart failure; Bisoprolol; Perindopril

Tailored Therapy of ACE Inhibitors in Stable Coronary Artery Disease: Pharmacogenetic Profiling of Treatment Benefit

Angiotensin-converting enzyme (ACE) inhibitors are among the most commonly used drugs in stable coronary artery disease as these agents have been proven to be effective for reducing the risk of cardiovascular morbidity and mortality. As with other drugs, individual variation in treatment benefit is likely. Such heterogeneity could be used to target ACE-inhibitor therapy to those patients most likely to benefit from treatment. However, prior attempts to target ACE-inhibitor therapy to those patients who are most likely to benefit of such prophylactic treatment in secondary prevention using clinical characteristics or the level of baseline risk appeared not to be useful. A new approach of 'tailored therapy' could be to integrate more patient-specific characteristics, such as the genetic information of patients. Pharmacogenetic research of ACE inhibitors in coronary artery disease patients is at a formative stage, and studies are limited. The Perindopril Genetic association (PERGENE) study is a large pharmacogenetic substudy of the randomized placebo-controlled European trial On Reduction of Cardiac Events with Perindopril in Patients with Stable Coronary Artery disease (EUROPA) trial, aimed to assess the feasibility of pharmacogenetic profiling of ACE-inhibitor therapy by perindopril. This article summarizes the recent findings of the PERGENE study and pharmacogenetic research of the treatment benefit of perindopril in stable coronary artery disease.

Genetic determinants of treatment benefit of the angiotensin-converting enzyme-inhibitor perindopril in patients with stable coronary artery disease

The efficacy of angiotensin-converting enzyme (ACE)-inhibitors in stable coronary artery disease (CAD) may be increased by targeting the therapy to those patients most likely to benefit. However, these patients cannot be identified by clinical characteristics. We developed a genetic profile to predict the treatment benefit of ACE-inhibitors exist and to optimize therapy with ACE-inhibitors. In 8907 stable CAD patients participating in the randomized placebo-controlled EUROPA-trial, we analysed 12 candidate genes within the pharmacodynamic pathway of ACE-inhibitors, using 52 haplotype-tagging-single nucleotide polymorphisms (SNPs). The primary outcome was the reduction in cardiovascular mortality, non-fatal myocardial infarction, and resuscitated cardiac arrest during 4.2 years of follow-up. Multivariate Cox regression was performed with multiple testing corrections using permutation analysis. Three polymorphisms, located in the angiotensin-II type I receptor and bradykinin type I receptor genes, were significantly associated with the treatment benefit of perindopril after multivariate adjustment for confounders and correction for multiple testing. A pharmacogenetic score, combining these three SNPs, demonstrated a stepwise reduction of risk in the placebo group and a stepwise decrease in treatment benefit of perindopril with an increasing scores (interaction P < 0.0001). A pronounced treatment benefit was observed in a subgroup of 73.5% of the patients [hazard ratio (HR) 0.67; 95% confidence interval (CI) 0.56-0.79], whereas no benefit was apparent in the remaining 26.5% (HR 1.26; 95% CI 0.97-1.67) with a trend towards a harmful effect. In 1051 patients with cerebrovascular disease from the PROGRESS-trial, treated with perindopril or placebo, an interaction effect of similar direction and magnitude, although not statistically significant, was observed. The current study is the first to identify genetic determinants of treatment benefit of ACE-inhibitor therapy. We developed a genetic profile which predicts the treatment benefit of ACE-inhibitors and which could be used to optimize therapy.

COMPARISON OF ENALAPRIL AND PERINDOPRIL IN PATIENTS WITH ARTERIAL HYPERTENSION AND LEFT VENTRICLE SYSTOLIC DYSFUNCTION

Aim. To compare efficacy of enalapril and perindopril in patients with arterial hypertension (HT) and left ventricle systolic dysfunction. Material and methods. Patients (n=51) with HT and left ventricle systolic dysfunction (ejection fraction&lt;45%) were included in the prospective open randomized comparative study. Patients were randomized into 2 groups of therapy with enalapril 10-20 mg BID (n=25) or with perindopril 4-8 mg OD (n=26). Hydrochlorothiazide (12,5-25 mg OD) was added in case of ineffective therapy. Routine clinical examination, ambulatory blood pressure (BP) monitoring, an electrocardiogram, an echocardiography were performed in all patients. Results. The 24-hour and night antihypertensive effect of enalapril was more prominent than this of perindopril. Target BP level was reached in 21 patients (84%) of enalapril group and in 20 patients (76,9%) of perindopril group. 8 (30,8%) patients of perindopril group did not reach night target BP level vs 3 (12%) patients of enalapril group. Similar improvement of the left ventricle systolic function was observed in both groups. Conclusion. Enalapril and perindopril demonstrated comparable antihypertensive and cardioprotective effect.

Angiotensin-converting enzyme inhibition with perindopril in patients with prior myocardial infarction and/or revascularization: A subgroup analysis of the EUROPA trial

The European trial on Reduction Of cardiac events with Perindopril in patients with stable coronary Artery disease (EUROPA) demonstrated the benefits of perindopril with respect to secondary prevention of cardiovascular risk in patients with stable coronary artery disease. To describe the clinical effects of perindopril in a subpopulation of patients from EUROPA with a history of myocardial infarction and/or revascularization. Of the 12,218 patients in the EUROPA study, 10,962 had a history of myocardial infarction and/or revascularization. In this EUROPA subpopulation, 7910 patients had a history of myocardial infarction and 6709 had a history of revascularization. Patients were randomized to treatment with perindopril 8mg/day or placebo. The primary endpoint was a composite of cardiovascular mortality, myocardial infarction and resuscitated cardiac arrest. After a mean follow-up of 4.2 years, treatment with perindopril 8mg/day was associated with a 22.4% reduction in the primary endpoint compared with placebo (p<0.001) in patients with a history of myocardial infarction. Patients with a history of myocardial revascularization showed a 17.3% reduction in the primary endpoint with perindopril versus placebo (p<0.05). In the combined population of patients with a history of myocardial infarction and/or revascularization, treatment with perindopril produced a 22.4% reduction in the primary endpoint compared with placebo (p<0.001). This study confirms the benefits of a high dose of angiotensin-converting enzyme inhibitor for the secondary prevention of cardiovascular risk among patients with a history of myocardial infarction and/or revascularization.

Perindopril: Beyond Lowering Blood Pressure

Perindopril, a prodrug ester of perindoprilat, is an angiotensin-converting enzyme inhibitor that lowers angiotensin II and potentiates bradykinin. This agent has proven efficacy in a wide range of cardiovascular diseases. Its efficacy, safety and tolerability are well established in the treatment of hypertension. Beyond pharmacodynamic effects shown in lowering blood pressure, perindopril was also involved in the improvement of endothelial function and the normalization of vascular and cardiac structure and function. Large morbidity-mortality trials, such as the European Trial on Reduction of Cardiac Events with Perindopril in Patients with Stable Coronary Artery Disease (EUROPA), Perindopril Protection Against Recurrent Stroke Study (PROGRESS) and Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA), have shown that treatment with perindopril reduces and prevents cardiovascular disease in a large range of patients with vascular diseases (including stable coronary disease), whether or not they are hypertensive.