Perindopril/Hydrochlorothiazide Combination in Hypertensive Patients Unresponsive to Hydrochlorothiazide Alone: A...

This study evaluated the efficacy and tolerability of perindopril erbumine, a long-acting ACE inhibitor, added to continuing hydrochlorothiazide (HCTZ) therapy in hypertensive patients (DBP of 95 to 114 mmHg) whose blood pressure did not normalize (supine DBP <90 mmHg) with HCTZ therapy alone. In this multicenter study, 252 patients received HCTZ 25 mg/day for 4 weeks; the 208 whose blood pressure did not normalize entered a 12-week, double-blind segment. These patients continued to receive HCTZ and were randomly assigned to perindopril (2, 4, or 8 mg) or placebo once daily. Mean supine SBP/DBP reductions from baseline for all HCTZ plus perindopril groups were significantly (p less-than-or-equal 0.05) greater than for HCTZ plus placebo. At the start of double-blind treatment, mean supine SBP/DBP readings were 146.1/97.0, 145.4/98.2 and 146.4/98.2 mmHg for the HCTZ plus perindopril 2-, 4-, and 8-mg groups, respectively, and 143.9/96.9 mmHg for HCTZ plus placebo group. At the final visit, mean reductions in supine SBP/DBP were 10.3/6.7, 9.6/8.0, and 9.3/6.3 mmHg for HCTZ plus perindopril 2, 4, and 8 mg, respectively, and 1.6/2.0 mmHg for HCTZ plus placebo. Significantly (p less-than-or-equal 0.05) more HCTZ plus perindopril patients (53.2%) than HCTZ plus placebo patients (24.5%) achieved an adequate response to therapy (supine DBP <90 mmHg or decrease by >10 mmHg). Incidences of adverse experiences were similar among treatment groups. There were no reports of first-dose hypotension. In patients unresponsive to HCTZ alone, the addition of perindopril at doses of 2--8 mg once daily provided safe and effective blood pressure reduction with no added side-effect liability.