The Antihypertensive Efficacy of the Triple Fixed Combination of Perindopril, Indapamide, and Amlodipine: The Results of the PETRA Study

• Published in: Advances in therapy Vol. 34; no. 7; pp. 1753 - 1763
• Main Authors: Ábrahám, György, Dézsi, Csaba András
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01.07.2017
• Subjects: Adult; Amlodipine - therapeutic use; Antihypertensive Agents - therapeutic use; Blood Pressure - drug effects; Blood Pressure Monitoring, Ambulatory; Cardiology; Drug Combinations; Endocrinology; Female; Health technology assessment; Humans; Hungary; Hypertension - drug therapy; Indapamide - therapeutic use; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Oncology; Original Research; Perindopril - therapeutic use; Pharmacology/Toxicology; Prospective Studies; Rheumatology; ABPM; Triple fixed combination; Metabolic parameters; Office blood pressure; Non-interventional study
• ISSN: 0741-238X; 1865-8652
• DOI: 10.1007/s12325-017-0572-1

Introduction The etiology of essential hypertension is multifactorial. Therefore, treatment with combinations of antihypertensive agents acting on multiple targets is necessary for successful therapy in the majority of patients. According to the experience and clinical data accumulated so far, combination therapy with three agents from different pharmacological classes is required in approx. 30% of patients in order to achieve long-term blood pressure control. The primary objective of the PETRA study was to evaluate the efficacy of blood pressure (BP) control with once daily administration of the different dosage strengths of the once-daily, triple fixed combination of perindopril, indapamide, and amlodipine. The evaluation was based on office BP readings and ambulatory blood pressure monitoring (ABPM) data gathered in routine clinical practice. Methods Data from 11,209 hypertensive patients (the proportion of female subjects was 47.6%) were processed and interpreted in a 3-month-long prospective, observational, non-interventional, open-label study conducted in 997 centers in Hungary. Results Mean baseline office BP was 156.58 ± 16.10/91.56 ± 9.33 mmHg (mean ± SD), whereas the mean duration of hypertension was 9.48 ± 7.19 years. Mean office BP decreased by 24.81 ± 15.47/11.41 ± 9.90 mmHg after switching to the triple fixed combination of perindopril, indapamide, and amlodipine ( p  < 0.0001). At the final visit 45.1% of patients took the 5/1.25/5 mg, 33.5% of them 10/2.5/5 mg, and 21.4% of them 10/2.5/10 mg strength of the perindopril/indapamide/amlodipine triple fixed combination. The 24-h blood pressure was obtained in 76 subjects. The mean 24-h BP decreased from 155.51 ± 17.43/85.28 ± 11.48 to 134.63 ± 12.51/77.83 ± 8.99 mmHg ( p  < 0.0001). Statistically significant ( p  < 0.0001) and clinically relevant improvement of a number of metabolic parameters—including total cholesterol (−8.6%), LDL-cholesterol (−11.4%), triglyceride (−12.1%), and fasting blood glucose (−6.6%) levels—was observed over the 3-month study period. Conclusions During the 3 months of the PETRA study, the outstanding 24-h antihypertensive efficacy of the triple fixed combination of perindopril, indapamide, and amlodipine was confirmed both by office BP readings and by ABPM recordings. This combination may offer a new therapeutic option for hypertensive patients who have failed to achieve the desired BP target on their previous dual combination therapy. Funding EGIS Pharmaceuticals PLC.