Effectiveness and metabolic effects of perindopril and diuretics combination in primary hypertension

The effectiveness as well as the metabolic effects of the combination of di uretics [hydrochlorothiazide (HCT) vs indapamide (IND)] and perindopril (P) in 14 patients (7 male, 7 female) aged 37-62 years with mild idiopathic hy pertension were studied. Following a 4-week washout period and a 4-week per iod of monotherapy with P (4 mg/daily), IND (2.5 mg/daily) or HCT (25 mg/da ily) was added for 4 weeks. Selection of the diuretic agent was random. Fol lowing a 4-week wash-out period from the diuretic, in which only P was give n, the alternative diuretic was administered for another period of 4 weeks. P decreased blood pressure levels significantly. However, the drug was more efficacious in patients with higher plasma renin activity (PRA). Combinati on treatment induced an additional decrease in the blood pressure levels, m ainly in patients with lower PRA. The combination of P + HCT was more effec tive than the combination P + IND. The addition of either HCT or IND evoked a small but statistically significant increase in serum glucose levels whi le fasting as well as during the 75 g oral glucose challenge. However, insu lin levels did not change significantly during the study. Small but not sta tistically significant changes in serum electrolytes and lipid parameters w ere observed during the various phases of the study, while a statistically significant increase in the serum uric acid was noticed when the combinatio n P + HCT was given. We conclude: (1) P in small doses is an effective and safe antihypertensive agent, (2) PRA has a predictive value in determining the effectiveness of P treatment, (3) the combination of P with small doses of HCT or IND is mor e efficacious than P alone, (4) the combination treatment has adverse effec ts in the carbohydrate tolerance, while there are not significant changes i n serum electrolyte and lipid parameters.