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This study shows that a fixed triple combination of perindopril, indapamide, and amlodipine effectively lowers blood pressure (BP) in patients with arterial hypertension (AH). The combination therapy also improved metabolic parameters and enhances treatment adherence.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Arterial hypertension (AH) often requires multiple antihypertensive drugs for effective blood pressure (BP) control.
- Approximately 30% of patients need three-drug combination therapy from different pharmacological classes for optimal BP management.
Purpose of the Study:
- To assess the efficacy of a once-daily, triple fixed-dose combination of perindopril, indapamide, and amlodipine in real-world clinical practice.
- To evaluate BP control and metabolic changes in patients with AH over a 3-month period.
Main Methods:
- Prospective, observational, open-label PETRA study involving 11209 patients with AH.
- Data collected included office BP measurements and 24-hour ambulatory BP monitoring (ABPM).
- Patients received a fixed triple combination of perindopril, indapamide, and amlodipine.
Main Results:
- Office BP significantly decreased by 24.81/11.41 mm Hg (p<0.0001) after 3 months.
- ABPM in 76 patients showed a significant reduction in 24-hour BP from 155.51/85.28 to 134.63/77.83 mm Hg (p<0.0001).
- Improvements observed in total cholesterol, LDL cholesterol, triglycerides, and fasting blood glucose levels.
Conclusions:
- The triple fixed-dose combination of perindopril, indapamide, and amlodipine demonstrates sustained 24-hour antihypertensive efficacy.
- This combination offers a new therapeutic option for AH patients not achieving BP targets with dual therapy.
- The single-pill approach supports adherence to treatment regimens.
Abstract:
Most patients with arterial hypertension (AH) for successful long-term blood pressure (BP) control require combination of antihypertensive drugs acting on various target organs. Accumulated experience shows that about 30 % of patients require combination therapy with 3 drugs from different pharmacological classes. Efficacy of BP control in real clinical practice with the use of various doses of perindopril, indapamide, and amlodipine as components of taken once-daily triple fixed combination was assessed in the 3-months prospective observational open-label PETRA study. In this study data of office BP measurements and 24-hour ambulatory BP monitoring (ABPM) were obtained from 11209 ambulatory patients (47.6 % women) with AH. Initial mean office BP (BPmoff) was 156.58±16.10 / 91.56±9.33 mm Hg, AH duration - 9.48±7.19 years. After switching to triple fixed dose combination of perindopril, indapamide, and amlodipine BPmoff decreased by 24.81±15.47 / 11.41±9.90 mm Hg (p<0.0001). Doses of perindopril, indapamide, and amlodipine in combination at the final visit were 5 / 1.25 / 5, 10 / 2.5 / 5, and 10 / 2.5 / 10 mg. 24-hour ambulatory BP monitoring (ABPM) was carried out in 76 patients. Mean 24-hour BP lowed from mean 155.51±17.43 / 85.28±11.48 down to 134.63±12.51 / 77.83±8.99 mm Hg (p<0.0001). Clinically relevant improvement of a number of parameters of metabolism occurred after 3 months of the study (in particular, lowering of levels of total and low-density lipoprotein cholesterol [-8.6 and - 11.4 %, respectively], triglycerides [-12,1 %], fasting blood glucose [-6.6 %]). Thus, results of the PETRA study confirmed 24-hour long antihypertensive efficacy of triple fixed dose combination of perindopril, indapamide, and amlodipine. This drug combination can present novel possibility in treatment of patients with AH who have not achieved target BP values on preceding dual combination therapy and fully corresponds with the single pill concept for formation of adherence to therapy.