Combination of perindopril/indapamide in secondary prevention of stroke and other vascular events: A combined analysis of ADVANCE, PROGRESS and HYVET trials
Perindopril/indapamide combination has been shown to reduce cardiovascular risk in different groups of patients. A total of 18,529 patients (9,272 receiving perindopril/indapamide and 9,257 receiving placebo) were included in this meta-analysis involving three large randomized clinical trials-ADVANCE, PROGRESS and HYVET. A non-significant reduction in fatal and non-fatal stroke was seen (Odds ratio 0.73; 95% Confidence Interval 0.49 to 1.09; z=1.52 and p= 0.13). The combination was associated with a significantly reduction of vascular death (Odds ratio 0.79; 95% Confidence Interval 0.69 to 0.90; z=3.48 and p=0.0005) and major cardio-vascular events (Odds ratio 0.72; 95% Confidence Interval 0.53 to 0.97; z=2.15 and p= 0.03). Fixed-combination of Perindopril and indapamide substantially reduced major cardiovascular event and vascular death. However, effect on stroke needs further evaluation.
ADVANCE Collaborative Group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): A randomised controlled trial. Lancet 2007; 370: 82940.
ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002; 288: 298197.
Bots ML, Remme WJ, Lu¨scher TF, Fox KM, Bertrand M, Ferrari R, Simoons M. L., Grobbee D. E. ACE Inhibition and Endothelial Function: Main Findings of PERFECT, a Sub-Study of the EUROPA Trial. Cardiovasc Drugs Ther. 2007; 21: 26979.
Brodszky V, Nagy V, Farsang C, Kárpáti K, Gulácsi L. The efficacy of indapamide in different cardiovascular outcome- meta-analysis. Orv Hetil. 2007; 148: 1203-11.
Brugts JJ, Ninomiya T, Boersma E, Remme WJ, Bertrand M, Ferrari R, Fox K, MacMahon S, Chalmers J, Simoons ML. The consistency of the treatment effect of an ACE-inhibitor based treatment regimen in patients with vascular disease or high risk of vascular disease: a combined analysis of individual data of ADVANCE, EUROPA, and PROGRESS trials. Eur Heart J. 2009; 30: 1385-94.
Bulpitt CJ, Beckett NS, Peters R, Leonetti G, Gergova V, Fagard R, Burch LA, Banya W, Fletcher AE. Blood pressure control in the Hypertension in the Very Elderly Trial (HYVET). J Hum Hypertens. 2011; 10: 1-7.
Carter AB. Hypotensive therapy in stroke survivors. Lancet 1970; 1: 48589.
Ceconi C, Fox KM, Remme WJ, Simoons ML, Bertrand M, Parrinello G, Kluft C, Blann A, Cokkinos D, Ferrari R; EUROPA Investigators; PERTINENT Investigators the Statistical Committee. ACE inhibition with perindopril and endothelial function. Results of a substudy of the EUROPA study: PERTINENT. Cardiovasc Res. 2007; 73: 23746.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA. 2003; 289: 256072.
de Leeuw PW. Combination perindopril/indapamide for the treatment of hypertension: A review. Expert Opin Pharmacother. 2011; Jun 9
Debbabi H, Bonnin P, Levy BI. Effects of blood pressure control with perindopril/indapamide on the microcirculation in hypertensive patients. Am J Hypertens. 2010; 23: 1136-43.
Gosse P. Perindopril/indapamide combination in the first-line treatment of hypertension and end-organ protection. Expert Rev Cardiovasc Ther. 2006; 4: 319-33.
Ghiadoni L. Perindopril for the treatment of hypertension.Expert Opin Pharmacother. 2011; 12: 1633-42.
Ghiadoni L, Magagna A, Kardasz I, Taddei S, Salvetti A. Fixed dose combination of perindopril and indapamide improves peripheral vascular function in essential hypertensive patients. Am J Hypertens. 2009; 22: 506-12.
Gueyffier F, Froment A, Gouton M. New meta-analysis of treatment trials of hypertension: improving the estimate of therapeutic benefit. J Hum Hypertens. 1996; 10: 18.
Hypertension-Stroke Cooperative Study Group. Effect of antihypertensive treatment on stroke recurrence. JAMA. 1974; 228: 40918.
HYVET Study Group. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008; 358: 1887-98.
Kang S, Wu YF, An N, Ren M. A systematic review and meta-analysis of the efficacy and safety of a fixed, low-dose perindopril-indapamide combination as first-line treatment of hypertension. Clin Ther. 2004 ;26: 257-70.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: Analysis of worldwide data. Lancet 2005; 365: 21723.
Laurent S. Very-low-dose combination of perindopril and indapamide: Efficacy on blood pressure and target-organ damage. J Hypertens Suppl. 2003; 21: S11-18.
Liu L, Wang Z, Gong L, Zhang Y, Thijs L, Staessen JA, Wang J. Blood pressure reduction for the secondary prevention of stroke: A Chinese trial and a systematic review of the literature. Hypertens Res. 2009; 32: 1032-40.
López-Sendón J, Swedberg K, McMurray J, Tamargo J, Maggioni AP, Dargie H, Tendera M, Waagstein F, Kjekshus J, Lechat P, Torp-Pedersen C; Task Force Members,Expert consensus document on angiotensin converting enzyme inhibitors in cardiovascular disease: The Task Force on ACE-inhibitors of the European Society of Cardiology. Eur Heart J. 2004; 25: 145470.
Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ, Cifkova R, Clément D, Coca A, Dominiczak A, Erdine S, Fagard R, Farsang C, Grassi G, Haller H, Heagerty A, Kjeldsen SE, Kiowski W, Mallion JM, Manolis A, Narkiewicz K, Nilsson P, Olsen MH, Rahn KH, Redon J, Rodicio J, Ruilope L, Schmieder RE, Struijker-Boudier HA, van Zwieten PA, Viigimaa M, Zanchetti A; European Society of Hypertension. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens. 2009; 27: 212158.
Mancia G, Grassi G. Protection of patients with diabetes, with or without hypertension: implications of ADVANCE for clinical practice. J Hypertens Suppl. 2009; 27: S19-23.
McClellan KJ, Markham A. Perindopril 2 mg/indapamide 0.625 mg. Fixed low-dose combination. Drugs. 1999; 58: 297-302.
PATS Collaborating Group. Post-stroke antihypertensive treatment study: A preliminary result. Chin Med J. 1995;108:71017.
Prempeh M, McGuire HL, Batch BC, Fan W, Svetkey LP. Hypertension Improvement Project (HIP): Study protocol and implementation challenges. Trials 2009; 10: 13.
PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet 2001; 358:103341
Psaty BM, Smith NL, Siscovick DS, Koepsell TD, Weiss NS, Heckbert SR, Lemaitre RN, Wagner EH, Furberg CD. Health outcomes associated with antihypertensive therapies used as firstline agents. A systematic review and meta-analysis. JAMA. 1997; 277:73945.
Rashid P, Leonardi-Bee J, Bath P. Blood pressure reduction and secondary prevention of stroke and other vascular events: A systematic review. Stroke 2003; 34; 2741-48.
Rodriguez-Granillo GA, Vos J, De Feyter PJ. Long-term effect of perindopril on coronary atherosclerosis progression (from the PERindoprils Prospective Effect on Coronary aTherosclerosis by Angiography and IntraVascular Ultrasound Evaluation [PERSPECTIVE] Study). Am J Cardiol. 2007; 100: 15963.
Rodriguez-Granillo GA, de Winter S, Bruining N, Ligthart JM, García-García HM, Valgimigli M, de Feyter PJ on behalf of the EUROPA/PERSPECTIVE Investigators. Effect of perindopril on coronary remodelling: Insights from a multicentre, randomized study. Eur Heart J 2007; 28: 232631.
Snyman JR, Wessels F. Perindopril: Do randomised, controlled trials support an ACE inhibitor class effect? A meta-analysis of clinical trials. Cardiovasc J Afr. 2009; 20: 127-34.
Stamler J, Stamler R, Neaton JD. Blood pressure, systolic and diastolic, and cardiovascular risks. U.S. population data. Arch Intern Med. 1993; 153: 598615.
SHEP Cooperative Research Group Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA. 1991; 265: 325564.
The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Guidelines on the management of stable angina pectoris. Eur Heart J. 2006; 27: 134181.
The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). 2007 Guidelines for the Management of Arterial Hypertension. J Hypertens. 2007; 25: 110587.
Wood D, DeBacker G, Faergam O, Graham I, Mancia G, Pyo¨ra¨la¨ K, and the task force. Prevention of coronary disease in clinical practice: Recommendation of the second Joint Task Force of European and other societies on Coronary Prevention. Atherosclerosis 1998; 140: 199270.
Copyright (c) 2011 Sougat Sourendra Sarkar
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).