Perindopril erbumine (
perindopril) is a
prodrug ester of
perindoprilat, an
angiotensin converting enzyme (
ACE) inhibitor.
Perindopril 4 to 8 mg once daily significantly reduces supine systolic blood pressure (SBP) and diastolic blood pressure (DBP) from baseline values in hypertensive patients. These reductions are maintained for at least 24 hours, as evidenced by trough/peak ratios of >50%. Vascular abnormalities associated with
hypertension were improved or normalised during
perindopril treatment.
Perindopril 4 to 8 mg once daily significantly decreased carotid-femoral aortic pulse wave velocity (PWV), improved arterial compliance, reduced left ventricular mass index and, in patients with recent cerebral ischaemia and/or
stroke, preserved cerebral blood flow despite significantly reducing SBP and DBP. Further research is needed to establish the significance of promising results showing that reductions in aortic 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 < or = 90 mm Hg) were significantly higher with
perindopril 4 to 8 mg once daily (67 to 80%) than with
captopril 25 to 50 mg twice daily (44 to 57%) in 3 randomised double-blind trials. In other clinical trials, the
antihypertensive effects of
perindopril were similar to those of other
ACE inhibitors (including
enalapril) and
calcium-channel antagonists. Combination treatment with
perindopril and an
antihypertensive agent from another treatment class provided additional benefits, either as first-line treatment or in patients failing 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 inhibitors;
cough is the most common event reported during treatment, and is also the most common adverse event responsible for treatment withdrawal.
CONCLUSIONS: