Antihypertensive efficacy of the ACE-inhibitor perindopril in the elderly

To assess the antihypertensive efficacy of the angiotensin-converting enzym e (ACE)-inhibitor, perindopril, in the elderly, patients >65 years of age w ith supine diastolic blood pressure (BP) greater than or equal to 90 and le ss than or equal to 110 mm Hg at the end of a 4-week placebo washout period were treated with perindopril 4-8 mg/daily vs placebo using a multicentre, randomised, double-biind, parallel group design. Of the 191 patients enter ed, 183 completed 8 weeks of double-blind therapy. Average age was 72-73 ye ars. Supine and standing BP at the end of the placebo run-in period were 17 3/96 vs 168/96 mm Hg. BPs were measured in the morning, 20-25 h after the p revious day's dose tie, at the end of the dosing interval). In the placebo group, supine and standing diastolic BP decreased by 3-4 mmHg, and systolic BP by 6-7 mm Hg. In the perindopril-group, diastolic BP decreased by 6-7 m m Hg and systolic BP by 10-13 mm Hg (both P < 0.01 vs placebo). These data indicate a substantial placebo response of particularly systolic BP in olde r hypertensives and indicate the importance of a parallel placebo-group to assess the extent of the actual drug's effect. Perindopril caused additiona l decreases in diastolic BP by about 2 mm Hg, and in systolic BP by 4-5 mm Hg. The extent of this drug-effect may be less in older vs middle-aged hype rtensives.