PERINDOPRIL: TRAITEMENT DE PREMIERE INTENTION DE L'HYPERTENSION ARTERIELLE

The effectiveness and acceptability of perindopril (P) as an antihypertensive agent were compared with those of captopril (C), atenolol (A) and a combined hydrochlorothiazide + amiloride diuretic (D) in three simultaneous multicentre double-blind trials involving 165, 173 and 165 patients respectively. After a 1 month placebo period, 3 groups of patients with essential hypertension whose DAP in supine position ranged from 95 to 125 mmHg (means: 103.9, 106.2 and 105.2 mmHg respectively) were allocated at random to treatment with either P (4 mg once a day) or C (25 mg b.d.) or A (50 mg once a day) or D (hydrochlorothiazide 50 mg + amiloride 5 mg once a day) during 3 months. The patients were re-examined monthly and their treatment was modified if their BP was insufficiently controlled (DAP > 90 mmHg): first, the dosage of the drug was doubled, then another antihypertensive agent was added, which was either a diuretic (studies with C or A) or a beta-blocker (studies with D). After 3 months, in the monotherapy group BP was controlled in 49 p. 100 of patients on P versus 49 p. 100 on C; 55 p. 100 on P versus 48 p. 100 on A and 72 p. 100 on P versus 72 p. 100 on D. The majority of patients who received P alone were controlled with 4 mg, and only 15 p. 100 required 8 mg. In cases where BP control necessitated a therapeutic combination, the addition of a diuretic was more effective with P than with C (26 p. 100 versus 8 p. 100) or A (23 p. 100 versus 10 p. 100), whereas the addition of a beta-blocker was less effective with P than with D (5 p. 100 versus 13 p. 100). The total percentage of controlled patients was greater with P than with C (75 p. 100 versus 57 p. 100, p = 0.016) or with A (78 p. 100 versus 58 p. 100, p = 0.006); there was non significant difference between P and D (78 p. 100 versus 84 p. 100). The percentages of patients who discontinued treatment were similar with P (6 p. 100 at most), C (4 p. 100), A (5 p. 100) and D (5 p. 100). Most of the side-effects reported with P were minor and unspecific, and their incidence was close to that observed with the other drugs. Cough was reported with P (1%) as well as with C (2 p. 100), A (1 p. 100) or D (1 p. 100). Compared with other treatments, the biochemical acceptability of P was good, and no case of renal impairment was recorded. It is concluded that the therapeutic effectiveness of P administered in doses from 4 to 8 mg daily is at least equal to that of the reference antihypertensive agents in their usual dosage, with few drug withdrawals and side-effects. P can therefore be prescribed as first-line treatment of essential hypertension. If a combined treatment is needed, diuretics should be preferred to beta-blockers.