Hypertension: uptitration with perindopril/amlodipine single-pill combination is safe and effective

  • Poulter NR & al.
  • Am J Cardiovasc Drugs
  • 28 Mar 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In mild-to-severe hypertension, all four incremental doses (3.5/2.5, 7/5, 14/5 and 14/10 mg) of the perindopril/amlodipine single-pill combination (SPC) showed significant improvement in blood pressure (BP) control, BP response and mean BP levels.
  • Overall BP-lowering effects with perindopril/amlodipine were similar to irbesartan/hydrochlorothiazide therapy.

Why this matters

  • Latest British guidelines recommend a renin-angiotensin system blocker plus a calcium channel blocker as the single optimal combination of drugs and this is one of the combinations ‘preferred’ in European guidance.

Study design

  • This study included 3270 patients with mild-to-severe hypertension who were randomly assigned to receive 4 incremental doses of perindopril/amlodipine SPC (n=1617) and irbesartan-based regimen (150, 150/12.5, 300/12.5 and 300/25 mg; n=1653).
  • Primary endpoint: proportion of patients with controlled BP at each uptitrated dose at 6 months.
  • Secondary endpoint: BP response (reduction in systolic and diastolic BP), mean BP levels, 24-hour ambulatory BP measurement (ABPM) and BP variability.
  • Funding: Servier.

Key results

  • BP control rates increased significantly from 21% to 30%, 37% and 42% with each increase in perindopril/amlodipine dose after 1, 2, 3 and 6 months, respectively (P<.005>
  • Similarly, BP response rates significantly increased from 47%, 62%, 68% and 73% at 1, 2, 3 and 6 months, respectively (P<.001>
  • After 6 months, mean BP level was reduced from 163.7/91.4 mmHg at baseline to 138.9/80.6 mmHg.
  • No significant difference was seen in 24-hour ABPM in patients who received irbesartan-based and perindopril/amlodipine therapy, but perindopril/amlodipine reduced BP variability vs irbesartan-based therapy.

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