Previous studies showed that postmenopausal women are more likely to have poorly controlled
hypertension than men of the same age. Whether this is caused by inadequate treatment or poor response to
antihypertensive agents remains unknown. The aim of this study is to analyze treatment response to the most potent renin angiotensin aldosterone system (RAAS) inhibitor
perindopril in different age categories in women and men. Individual patient data were used from the combined European Trial on Reduction of
Cardiac Events With
Perindopril (EUROPA),
Perindopril Protection Against Recurrent
Stroke Study (PROGRESS), and Action in Diabetes and
Vascular disease:
Preterax and
Diamicron-MR Controlled Evaluation (ADVANCE) trials, which include patients with
vascular disease (n = 29,463). We studied the relative and absolute changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) during a 4-week run-in phase in which all patients were treated with the
perindopril-based treatment in different age categories. In total, 8366 women and 21,097 men were included in the analysis. Women greater than 65 years of age showed a significantly smaller blood pressure reduction after
perindopril treatment (2.8 mmHg [95% confidence interval {CI} = 0.1-5.5] less reduction compared to women ≤45 years, p = 0.039). In men, the SBP reduction after
perindopril in patients greater than 55-65 and greater than 65 years was lower compared to the age category less than or equal to 45 years (adjusted mean difference >55-65: 2.8 mmHg [95% CI = 1.8-3.7], p < 0.001, >65: 3.7 mmHg [95% CI = 2.7-4.7], p < 0.001). A trend of less blood pressure reduction was seen with ageing in both men and women (p < 0.001). To conclude, we observed that in both women and men the
perindopril leads to less SBP reduction with increasing age, whereas the DBP reduction increases with age. More research is needed to determine whether it would be beneficial to use age-adjusted
perindopril dosages.