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Combination therapy in the extended cardiovascular continuum: a focus on perindopril and amlodipine

Claudio Borghi1, Martino Morbini, Arrigo F G Cicero

  • 1Department of Internal Medicine, Aging and Clinical Nephrology, University of Bologna, Bologna, Italy.

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|January 16, 2015
PubMed

Insights

Combining ACE inhibitors like perindopril with calcium channel blockers like amlodipine effectively slows cardiovascular disease progression. This combination offers superior cardiovascular protection in high-risk hypertensive patients by targeting multiple disease pathways.

Area of Science:

  • Cardiology
  • Pharmacology
  • Gerontology

Background:

  • Cardiovascular disease (CVD) progresses via atherosclerosis-related and age-related pathways, converging to end-stage heart disease.
  • The Renin-Angiotensin-Aldosterone System (RAAS) inhibitors can slow CVD progression along the atherosclerotic pathway, but protection varies among agents.
  • Calcium channel blockers (CCBs) demonstrate cardiovascular protective effects, particularly against cerebrovascular disease risk.

Purpose of the Study:

  • To evaluate the combined cardiovascular protective effects of perindopril (an ACE inhibitor) and amlodipine (a CCB) in hypertensive patients.
  • To assess if this combination strategy offers enhanced protection compared to other antihypertensive regimens.
  • To determine if targeting multiple CVD pathways with these agents reduces overall cardiovascular risk.

Main Methods:

  • The study references findings from the AngloScandinavian Cardiac Outcomes Trial (ASCOT).
  • ASCOT compared a combination of perindopril and amlodipine against a regimen of beta-blocker and thiazide in at-risk hypertensive patients.
  • The evaluation focused on cardiovascular protection and blood pressure reduction.

Main Results:

  • The combination of perindopril and amlodipine provided superior cardiovascular protection compared to beta-blocker and thiazide.
  • These agents attenuate CVD effects across multiple stages of the cardiovascular continuum.
  • The combined antihypertensive and vascular effects translated into significant real-life clinical benefits.

Conclusions:

  • A strategy combining ACE inhibitors (perindopril) and CCBs (amlodipine) effectively targets multiple CVD pathways.
  • This combination strategy significantly reduces cardiovascular risk and lowers blood pressure in hypertensive patients.
  • Complementary vascular effects of perindopril and amlodipine enhance cardiovascular protection and minimize side-effects.

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