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Perindopril 3.5 mg/amlodipine 2.5 mg versus renin-angiotensin system inhibitor monotherapy as first-line treatment in hypertension: a combined analysis

The high prevalance of hypertension1 and its associated high risk of morbidity and mortality2-4 underscore the need for better strategies to prevent, detect and treat hypertension and, hence reduce cardiovascular outcomes. 

Many patients still are diagnosed with hypertension each year, making rapid and effective control of blood pressure (BP) crucial.   Appropiate first-line treatment is important, and special attentition should be paid to the positive effects of early BP lowering. Perindopril 3.5mg/amlodipine 2.5 mg (P3.5/A2.5) is a single-pill combination suitable for first line treatment. 

Individual patient data from three randomized controlled trials that evaluated the efficacy of P3.5/A2.5 versus RAS-inhibitor monotherapies in patients with hypertension5-7 were used to perform a combined analysis.

In a large population, early administration of P.35/A2.5 resulted in a significantly greater BP-lowering effect than perindopril, irbesartan or valsartan monotherapies after 1 month. Reducing BP levels withing a month of treatment may reasonably be expected to lead to a reduced risk of cardiovascular events. 

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Table 1. Mean change from baseline in SBP/DBP after 1 month of treatment with perindopril 3.5 mg/amlodipine 2.5 mg combination versus each of the renin–angiotensin system-inhibitor monotherapies within each study

  1. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365:217–223.
  2. Yusuf S, Hawkins S, Ounpuu S, Dans T, Avezum A, Lanas F, et al., INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364: 937–952.
  3. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attrib-utable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2224–2260.
  4. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360:1903–1913.
    1. Laurent S, Parati G, Chazova I, Sirenko Y, Erglis A, Laucevicius A, Farsang C. Randomized evaluation of a novel, fixed-dose combination of perindopril 3.5 mg/amlodipine 2.5 mg as a first-step treatment in hypertension. J Hypertens 2015; 33:653–661.
    1. Poulter N, Whitehouse A, O’Brien E, Sever PS. A randomized, double-blind study of the efficacy and safety of new first-line perindopril/amlodipine combinations. J Hypertens 2015; 33 (eSuppl. 1):e194.
  5. 37Mancia G, Asmar R, Amodeo C, Mourad JJ, Taddei S, Alcocer Gamba MA, et al. Comparison of single-pill strategies first line in hypertension: perindopril/amlodipin

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