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Evidence for benefits of perindopril in hypertension and its complications.
Am J Hypertens. 2005 Sep; 18(9 Pt 2):155S-162S.AJ

Abstract

Structural and functional changes in large and small arteries in hypertension, even at early stages, may affect one or several end organs such as the brain, heart, and kidneys, contributing to cardiovascular morbidity and mortality. Therefore, modern treatment strategies should not only target blood pressure (BP) reduction but also normalize vascular structure and function. The purpose of this article is to review the large body of evidence, from randomized double-blind clinical trials, that has been gathered in regard to the angiotensin-converting enzyme (ACE) inhibitor perindopril, demonstrating its efficacy in reducing BP, reversing abnormalities of vascular structure and function in patients with essential hypertension, and ultimately preventing cardiovascular events. At the site of small resistance arteries, long-term treatment with perindopril, but not atenolol, reduced arterial wall hypertrophy for a given BP reduction. The improvement in small artery function in response to structural changes is exemplified at the site of the coronary circulation. Perindopril increased coronary blood flow and coronary reserve, in parallel with the regression of periarteriolar and interstitial collagen of coronary arterioles. At the site of large arteries, long-term treatment with perindopril reduced carotid and radial artery wall hypertrophy, and reduced carotid artery internal diameter. In response to these structural changes, large artery function improved at the site of the carotid and brachial arteries, showing a higher arterial distensibility, and at the site of the coronary circulation, showing a normalized arterial dilation in response to a cold pressor test or an increase in blood flow. Moreover, in patients with end-stage renal disease, perindopril decreased pulse wave velocity independently of BP changes, resulting in a highly significant relative risk reduction in all-cause and cardiovascular mortality. The multifactorial antiatherosclerotic profile of perindopril suggests a beneficial effect not only in patients with uncomplicated hypertension but also in patients with established coronary heart disease or previous stroke, as exemplified by the EUropean trial on Reduction Of coronary events with Perindopril in stable coronary Artery disease (EUROPA) and the Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS).

Authors+Show Affiliations

Department of Pharmacology and INSERM U652, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France. stephane.laurent@egp.ap-hop-paris.fr

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

16125052

Citation

Laurent, Stéphane. "Evidence for Benefits of Perindopril in Hypertension and Its Complications." American Journal of Hypertension, vol. 18, no. 9 Pt 2, 2005, 155S-162S.
Laurent S. Evidence for benefits of perindopril in hypertension and its complications. Am J Hypertens. 2005;18(9 Pt 2):155S-162S.
Laurent, S. (2005). Evidence for benefits of perindopril in hypertension and its complications. American Journal of Hypertension, 18(9 Pt 2), 155S-162S.
Laurent S. Evidence for Benefits of Perindopril in Hypertension and Its Complications. Am J Hypertens. 2005;18(9 Pt 2):155S-162S. PubMed PMID: 16125052.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evidence for benefits of perindopril in hypertension and its complications. A1 - Laurent,Stéphane, PY - 2005/05/17/received PY - 2005/05/27/accepted PY - 2005/8/30/pubmed PY - 2006/1/6/medline PY - 2005/8/30/entrez SP - 155S EP - 162S JF - American journal of hypertension JO - Am. J. Hypertens. VL - 18 IS - 9 Pt 2 N2 - Structural and functional changes in large and small arteries in hypertension, even at early stages, may affect one or several end organs such as the brain, heart, and kidneys, contributing to cardiovascular morbidity and mortality. Therefore, modern treatment strategies should not only target blood pressure (BP) reduction but also normalize vascular structure and function. The purpose of this article is to review the large body of evidence, from randomized double-blind clinical trials, that has been gathered in regard to the angiotensin-converting enzyme (ACE) inhibitor perindopril, demonstrating its efficacy in reducing BP, reversing abnormalities of vascular structure and function in patients with essential hypertension, and ultimately preventing cardiovascular events. At the site of small resistance arteries, long-term treatment with perindopril, but not atenolol, reduced arterial wall hypertrophy for a given BP reduction. The improvement in small artery function in response to structural changes is exemplified at the site of the coronary circulation. Perindopril increased coronary blood flow and coronary reserve, in parallel with the regression of periarteriolar and interstitial collagen of coronary arterioles. At the site of large arteries, long-term treatment with perindopril reduced carotid and radial artery wall hypertrophy, and reduced carotid artery internal diameter. In response to these structural changes, large artery function improved at the site of the carotid and brachial arteries, showing a higher arterial distensibility, and at the site of the coronary circulation, showing a normalized arterial dilation in response to a cold pressor test or an increase in blood flow. Moreover, in patients with end-stage renal disease, perindopril decreased pulse wave velocity independently of BP changes, resulting in a highly significant relative risk reduction in all-cause and cardiovascular mortality. The multifactorial antiatherosclerotic profile of perindopril suggests a beneficial effect not only in patients with uncomplicated hypertension but also in patients with established coronary heart disease or previous stroke, as exemplified by the EUropean trial on Reduction Of coronary events with Perindopril in stable coronary Artery disease (EUROPA) and the Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS). SN - 0895-7061 UR - https://www.unboundmedicine.com/medline/citation/16125052/Evidence_for_benefits_of_perindopril_in_hypertension_and_its_complications_ L2 - https://academic.oup.com/ajh/article-lookup/doi/10.1016/j.amjhyper.2005.05.004 DB - PRIME DP - Unbound Medicine ER -