Perindopril: the reasonable choice in patients with coronary artery disease

Recent studies in patients with coronary artery disease (CAD) have suggested that angiotensin-converting enzyme (ACE) inhibitors may have benefits beyond blood pressure reduction alone. Increased arterial stiffness, itself an emerging risk factor for CAD, adversely influences ventricular vascular interaction, leading to an increased central aortic pulse pressure. A number of recent studies have demonstrated a clear relationship between central pulse pressure and angiographic CAD. Furthermore, aortic stiffness also correlates with CAD. These studies are consistent with the hypothesis that central aortic stiffness may promote the development of CAD and that therapeutic intervention targeted at reducing arterial stiffness may be of benefit in patients with CAD. The ACE inhibitor, perindopril, has been shown to decrease arterial stiffness, largely independently of any effect on peripheral blood pressure. Results of the recent REASON study demonstrate that perindopril, in combination with indapamide, reduces central systolic and pulse pressure to a greater degree than the beta-blocker atenolol and that this effect is due to improved arterial stiffness and decreased wave reflection. In addition to its other beneficial effects, such as improved endothelial function and decreased inflammation, these haemodynamic effects of perindopril may therefore have contributed to the decrease in cardiovascular events seen in patients in the EUROPA study. Overall, perindopril, in addition to lowering peripheral blood pressure, decreases arterial stiffness and central pulse pressure. In individuals with CAD, perindopril would thus appear to be a very reasonable choice.