ONCE-DAILY PERINDOPRIL VERSUS SLOW-RELEASE DILTIAZEM IN THE TREATMENTOF MILD-TO-MODERATE ESSENTIAL-HYPERTENSION

The efficacy and acceptability of the angiotensin-converting enzyme (A CE) inhibitor perindopril were compared with those of an established t reatment for hypertension in Canada, slow release diltiazem. Hypertens ive patients aged 18 to 64 years presenting a mean sitting diastolic b lood pressure (DBP) between 95 and 110 mmHg inclusive were randomized if they were without any concurrent serious renal, hepatic, cardiac or psychiatric illnesses. A total of 49 of 83 patients qualified for ran domization after four weeks on placebo, 23 were assigned to the perind opril treatment group and 26 to the diltiazem treatment group. Startin g doses (4 mg od in the perindopril group and 120 mg [60 mg bid] in th e diltiazem group) were increased to a maximum of 8 mg od in the perin dopril group and to 360 mg (180 mg bid) in the diltiazem group if DBF remained above 90 mmHg. Hydrochlorothiazide was added at week 8 if goa l blood pressure was not achieved with the maximum dose. Both groups w ere comparable at randomization; baseline systolic blood pressure (SGP )/DBP were 153/100 mmHg and 150/99 mmHg in the perindopril and diltiaz em groups, respectively. A significant decrease in SBP/DBP was observe d from the second week of treatment: -10/-8 mmHg in the perindopril gr oup and -8/-8 mmHg in the diltiazem group. This fall in blood pressure was maintained throughout the duration of the trial: -13/-9 and -13/- 11 mmHg for the perindopril and diltiazem groups, respectively, at wee k 12, at which time monotherapy was taken by over 80% of patients and compliance was consistently over 90%. One patient treated with perindo pril withdrew before the end of the trial due to depression associated with personal problems. Systematic questioning about an exhaustive li st of 11 symptoms at all visits showed no significant trends and no se rious events. There were no significant changes in any laboratory para meters. Both drugs had a neutral effect on serum lipids, glucose, seru m markers of kidney and renal function and on hematological parameters . In conclusion, this Canadian multicentre trial confirmed that the ef ficacy and acceptability of the once daily ACE inhibitor perindopril, administered in a simple dosing scheme of 4 to 8 mg, is equivalent to that of slow release diltiazem in the treatment of hypertension.