Perindopril/indapamide 2/0.625 mg/day : A review of its place in the management of hypertension

• Published in: Drugs (New York, N.Y.) Vol. 61; no. 8; pp. 1211 - 1229
• Main Authors: MATHESON, Anna J, CHEER, Susan M, GOA, Karen L
• Format: Journal Article
• Language: English
• Published: Auckland Adis International 2001
• Subjects: Adult; Age Factors; Aged; Animals; Antihypertensive agents; Antihypertensive Agents - administration & dosage; Antihypertensive Agents - adverse effects; Antihypertensive Agents - pharmacokinetics; Antihypertensive Agents - pharmacology; Biological and medical sciences; Blood Pressure - drug effects; Cardiovascular system; Disease Models, Animal; Humans; Hypertension - diagnosis; Hypertrophy, Left Ventricular - chemically induced; Hypokalemia - chemically induced; Indapamide - administration & dosage; Indapamide - adverse effects; Indapamide - pharmacokinetics; Indapamide - pharmacology; Kidney Diseases - chemically induced; Medical sciences; Middle Aged; Perindopril - administration & dosage; Perindopril - adverse effects; Perindopril - pharmacokinetics; Perindopril - pharmacology; Pharmacology. Drug treatments; Randomized Controlled Trials as Topic; Human; Hypertension; Drug combination; Indapamide; Toxicity; Low dose; Treatment efficiency; Cardiovascular disease; Review; Diuretic; Chemotherapy; Treatment; Antihypertensive agent; Perindopril; Pharmacokinetics; ACE inhibitor
• ISSN: 0012-6667; 1179-1950
• DOI: 10.2165/00003495-200161080-00018

The fixed low-dose combination of the ACE inhibitor perindopril and the non-thiazide diuretic indapamide has been evaluated in the management of patients with mild to moderate hypertension. Combination therapy aims to improve overall therapeutic efficacy while minimising adverse effects. In well-designed multicentre clinical trials, perindopril/indapamide at doses ranging from 2/0.625 to 8/2.5 mg/day was significantly more effective than placebo in achieving adequate blood pressure (BP) control. A similar reduction in supine BP was observed when combined perindopril/indapamide 2/0.625 mg/day was compared with losartan 50 mg/day or atenolol 50 mg/day. Similar reductions in 24-hour ambulatory BP were also seen with perindopril/indapamide 2/0.625 mg/day and irbesartan 150 mg/day. However, response and normalisation rates were significantly higher with combination therapy than with losartan or irbesartan monotherapy. Combined perindopril/indapamide 2/0.625 mg/day therapy effectively reduced BP in elderly patients aged 65 to 85 years to a significantly greater extent than either atenolol 50 mg/day or placebo. Supine BP was also normalised in approximately two-thirds of patients in a small noncomparative trial in patients with hypertension and renal impairment. Low-dose perindopril/indapamide 2/0.625 mg/day was well tolerated in clinical trials; the most common adverse events were headache and cough. Hypokalaemia, associated with the use of diuretics, occurred with a higher incidence with combined perindopril/indapamide 2/0.625 mg/day therapy than with either atenolol 50 mg/day or placebo. Perindopril/indapamide 2/0.625 mg/day has shown efficacy in well designed comparative trials with atenolol, losartan and irbesartan including elderly patients and patients with renal impairment. Studies comparing this dosage of perindopril/ indapamide with other combination therapies would be beneficial in allowing the place of perindopril/indapamide to be more accurately determined. The fixed-low dose combination of perindopril/indapamide provides a promising and well tolerated treatment option in the management of patients with mild to moderate hypertension.