First-line treatment in hypertension. Role of perindopril

Once-daily administration of perindopril 4mg has been compared with captopril 25mg twice daily, atenolol 50mg once daily or a combination of hydrochlorothiazide 50mg plus amiloride 5mg once daily in double-blind studies of patients with supine diastolic blood pressures between 95 and 125mm Hg. After 3 months' treatment, the average decrease in supine systolic blood pressure with perindopril (26.5mm Hg) was significantly greater than that obtained with captopril (18.9mm Hg) and atenolol (20.6mm Hg), and non-significantly different from that achieved with the diuretic combination (30.6mm Hg). Perindopril reduced diastolic blood pressure by a greater extent than captopril (18.1 vs 11.7mm Hg), whereas the reductions were similar when compared with atenolol (17.4 vs 15.6mm Hg) and the diuretics (19.1 vs 18.4mm Hg). Target blood pressure (supine diastolic less than or equal to 90mm Hg) was achieved in 49 to 72% of patients on perindopril 4 mg/day and in an additional 15% of patients by doubling the dosage. In patients on perindopril who required an additional antihypertensive agent, a diuretic was more effective than a beta-blocker. Withdrawal rates due to adverse effects were similar in all treatment groups and ranged between 4 and 6%. Perindopril was well tolerated. In conclusion, these studies demonstrate that perindopril may be considered as a suitable first-line treatment for mild to moderate hypertension.