Perindopril - An updated review of its use in hypertension

Perindopril erbumine (perindopril) is a prodrug ester of perindoprilat, an angiotensin converting enzyme (ACE) inhibitor. Perindopril 4 to 8mg once da ily significantly reduces supine systolic blood pressure (SBP) and diastoli c blood pressure (DBP) from baseline values in hypertensive patients. These reductions are maintained for at least 24 hours, as evidenced by trough/pe ak ratios of > 50%. Vascular abnormalities associated with hypertension were improved or normal ised during perindopril treatment. Perindopril 4 to 8mg once daily signific antly decreased carotid-femoral aortic pulse wave velocity (PWV), improved arterial compliance, reduced left ventricular mass index and, in patients w ith recent cerebral ischaemia and/or stroke, preserved cerebral blood flow despite significantly reducing SEP and DBP, Further research is needed to e stablish the significance of promising results showing that reductions in a ortic PWV were associated with reduced mortality in patients with end-stage renal failure, a third of whom received perindopril, Response rates (numbers of patients with supine DBP less than or equal to 9 0mm Hg) were significantly higher with perindopril 4 to 8mg once daily (67 to 80%) than with captopril 25 to 50mg twice daily (44 to 57%) in 3 randomi sed double-blind trials, In other clinical trials, the antihypertensive eff ects of perindopril were similar to those of other ACE inhibitors (includin g enalapril) and calcium-channel antagonists. Combination treatment with pe rindopril and an antihypertensive agent from another treatment class provid ed additional benefits, either as first-line treatment or in patients faili ng to respond to monotherapy, Perindopril monotherapy was also effective in the elderly and in patients with hypertension and concomitant disease. Perindopril has a similar adverse event profile to that of other ACE inhibi tors; cough is the most common event reported during treatment, and is also the most common adverse event responsible for treatment withdrawal, Conclusions: Perindopril is a well tolerated ACE inhibitor that is signific antly better than captopril (in terms of response rates) in the treatment o f hypertension, and as effective as other ACE inhibitors. Perindopril appea rs to reverse some of the vascular abnormalities associated with hypertensi on, including arterial stiffness and left ventricular hypertrophy, although further research is needed to confirm promising results regarding its abil ity to decrease associated cardiovascular morbidity and mortality. Results from ongoing studies will help confirm the place of perindopril in the trea tment of hypertension; currently, it is an effective and well tolerated tre atment for patients with mild to moderate essential hypertension.