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Long-term tolerance of perindopril in hypertensive patients with impaired renal function
M Dratwa1, J Sennesael, F Taillard
1Hôpital Universitaire Brugman, Brussels, Belgium.
Insights
Perindopril effectively lowered blood pressure in hypertensive patients with impaired renal function. The study found perindopril safe and well-tolerated, with no significant adverse effects on renal function or potassium levels.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Hypertension is a significant risk factor for cardiovascular and renal diseases.
- Patients with impaired renal function often present complex challenges in managing hypertension.
- ACE inhibitors like perindopril are commonly used, but their safety in renal impairment requires careful evaluation.
Purpose of the Study:
- To assess the long-term safety and efficacy of perindopril in hypertensive patients with impaired renal function.
- To monitor the impact of perindopril on blood pressure, renal function parameters, and electrolyte balance.
Main Methods:
- A long-term study involving 36 hypertensive patients with impaired renal function.
- Perindopril administered orally in single daily doses, with initial dosages adjusted based on creatinine clearance (Clcr).
- Dosage adjustments and addition of diuretics were made for uncontrolled blood pressure; adverse events and compliance were monitored.
Main Results:
- Significant reductions in both systolic and diastolic blood pressure were observed (p < 0.001).
- No statistically significant changes in plasma creatinine, Clcr, or kalemia were noted during the study.
- Six patients were withdrawn due to adverse events, two for poor compliance, and three for personal reasons.
Conclusions:
- Perindopril demonstrated significant blood pressure-lowering effects in hypertensive patients with impaired renal function.
- The drug was generally well-tolerated, with no significant detrimental impact on renal function or potassium levels.
- Perindopril can be considered a safe and effective treatment option for this patient population.
Abstract:
Thirty-six hypertensive patients with impaired renal function entered a long-term study to assess the safety of perindopril. There were 28 men and 8 women of mean age 57.1 +/- 2.0 years (mean +/- SEM). The duration of documented hypertension was 7.3 +/- 1.2 years. Perindopril was given orally in single daily doses. The initial dosage was chosen according to the degree of renal function impairment: 29 patients received 4 mg o.d. [creatinine clearance (Clcr), 42.2 +/- 3.2 ml.min-1] and 7 patients received 2 mg o.d. (Clcr, 22.3 +/- 3.1 ml.min-1). Patients in whom blood pressure was not controlled had their dose doubled and then, if necessary, an additional diuretic therapy was added at subsequent visits. Six patients were withdrawn for adverse events (myocardial infarction, pneumonia, leucopenia in a patient who had lupus, diabetes mellitus, skin rash, epigastric pain), two patients were withdrawn for poor compliance, and three for personal convenience. The mean duration of treatment was 10.2 months with a range of 3-12 months (excluding one patient who died from myocardial infarction in the first days of the study and was not included in the analysis). Systolic and diastolic blood pressure decreased significantly (from 170.5/100.6 +/- 3.4/1.8 mm Hg to 151.8/88.8 +/- 3.0/1.7 mm Hg, n = 35, p less than 0.001). Baseline and final values of plasma creatinine (from 223.7 +/- 22.7 to 234.7 +/- 28.5 mumols/l), Clcr (42.5 +/- 3.2 to 45.7 +/- 4.6 ml.min-1), and kalemia (from 4.4 +/- 0.1 to 4.7 +/- 0.1 mmol/L) were not statistically different.(ABSTRACT TRUNCATED AT 250 WORDS)