Comparative efficacy of perindopril and enalapril once daily using 24-hourambulatory blood pressure monitoring

ACE inhibitors are important therapeutic agents in controlling hypertension , correcting some of its pathophysiological derangement and improving its p rognosis. While there are many such agents, there may be some important dif ferences between them. This placebo run-in, double blind, crossover study, using 24-hour ambulatory blood pressure monitoring, compares the efficacy o f perindopril 4-8 mg and enalapril 10-20 mg as once daily antihypertensive agents on 32 patients. For diastolic blood pressure (DBP), perindopril had a placebo-corrected peak (P) reduction of blood pressure (BP) of -6.4 +/- 1 .3 mmHg vs its placebo-corrected trough (T) of -5.2 +/- 1.7 mmHg. Enalapril had a reduction in DBP of -8.5 +/- 1.3 mmHg (P) and -5.7 +/- 1.7 mmHg (T). For systolic blood pressure (SBP), perindopril had a reduction of -7.5 +/- 1.6 mmHg (P) vs -7.3 +/- 2.2 mmHg (T) compared to enalapril with -10.8 +/- 1.6 mmHg (P) vs -8.3 +/- 2.3 mmHg (T). Placebo-corrected trough-to-peak ra tio (SBP/DBP) for perindopril was 0.97/0.81 vs 0.77/0.67 for enalapril. The re was no difference noted in 24-hour mean BP, area under the curve or post -dose casual BP measurements. Both perindopril and enalapril were well tole rated and the two treatment groups had similar safety profiles. Perindopril thus had a predictable and sustained blood pressure effect giving a 24-hou r cover for the patient without excessive peak effect or poor trough effect .