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Angiotensin-converting enzyme inhibition by perindopril in the treatment of cardiovascular disease.
Expert Rev Cardiovasc Ther 2009; 7(4):345-60ER

Abstract

The angiotensin-converting enzyme (ACE) inhibitor perindopril (Coversyl) is a long-acting lipophilic drug with a high-tissue affinity for the ACE. ACE inhibition by perindopril has two main effects: it inhibits the angiotensin II formation and potentiates bradykinin. Perindopril is one of the ACE inhibitors that has been extensively studied in randomized clinical trials within various patient populations. The clinical efficacy has been demonstrated in patients with hypertension, diabetes mellitus, cerebrovascular disease, stable coronary artery disease (CAD) and heart failure. Perindopril has a positive safety and tolerability profile. Therefore, perindopril, as an ACE inhibitor, has an established place in the major clinical treatment guidelines. This article discusses several studies that have shown that an antihypertensive treatment with perindopril reduces and prevents cardiovascular events in a large range of patients with established vascular disease. The observed cardioprotective benefits of perindopril were independent of blood pressure. The outcome of these and other trials support the concept of specific cardioprotective properties of ACE inhibition by perindopril in addition to the blood pressure-lowering effects, such as anti-atherosclerotic, anti-inflammatory and antithrombotic properties. In addition, the observed consistency of the treatment benefit across subgroups indicates that the absolute benefits conferred by treatment are mainly established by each patient's future risk of vascular complications, rather than their initial blood pressure level or other risk factors. This article describes these issues according to the main studies with perindopril or perindopril-based regimens, concluding that the blood pressure-dependent and -independent cardioprotective effects extend to all patients with vascular disease. This concept supports the provision of ACE inhibitor-based treatment, not on the basis of arbitrary cut-off points for blood pressure but rather on assessment of vascular risk, which is raised in patients with stable CAD, diabetes and stroke.

Authors+Show Affiliations

Department of Cardiology, Erasmus Medical Centers, Gravendijkwal 230, 3015CE Rotterdam, The Netherlands. j.brugts@erasmusmc.nlNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19379059

Citation

Brugts, Jasper J., et al. "Angiotensin-converting Enzyme Inhibition By Perindopril in the Treatment of Cardiovascular Disease." Expert Review of Cardiovascular Therapy, vol. 7, no. 4, 2009, pp. 345-60.
Brugts JJ, Ferrari R, Simoons ML. Angiotensin-converting enzyme inhibition by perindopril in the treatment of cardiovascular disease. Expert Rev Cardiovasc Ther. 2009;7(4):345-60.
Brugts, J. J., Ferrari, R., & Simoons, M. L. (2009). Angiotensin-converting enzyme inhibition by perindopril in the treatment of cardiovascular disease. Expert Review of Cardiovascular Therapy, 7(4), pp. 345-60. doi:10.1586/erc.09.2.
Brugts JJ, Ferrari R, Simoons ML. Angiotensin-converting Enzyme Inhibition By Perindopril in the Treatment of Cardiovascular Disease. Expert Rev Cardiovasc Ther. 2009;7(4):345-60. PubMed PMID: 19379059.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Angiotensin-converting enzyme inhibition by perindopril in the treatment of cardiovascular disease. AU - Brugts,Jasper J, AU - Ferrari,Roberto, AU - Simoons,Maarten L, PY - 2009/4/22/entrez PY - 2009/4/22/pubmed PY - 2009/7/16/medline SP - 345 EP - 60 JF - Expert review of cardiovascular therapy JO - Expert Rev Cardiovasc Ther VL - 7 IS - 4 N2 - The angiotensin-converting enzyme (ACE) inhibitor perindopril (Coversyl) is a long-acting lipophilic drug with a high-tissue affinity for the ACE. ACE inhibition by perindopril has two main effects: it inhibits the angiotensin II formation and potentiates bradykinin. Perindopril is one of the ACE inhibitors that has been extensively studied in randomized clinical trials within various patient populations. The clinical efficacy has been demonstrated in patients with hypertension, diabetes mellitus, cerebrovascular disease, stable coronary artery disease (CAD) and heart failure. Perindopril has a positive safety and tolerability profile. Therefore, perindopril, as an ACE inhibitor, has an established place in the major clinical treatment guidelines. This article discusses several studies that have shown that an antihypertensive treatment with perindopril reduces and prevents cardiovascular events in a large range of patients with established vascular disease. The observed cardioprotective benefits of perindopril were independent of blood pressure. The outcome of these and other trials support the concept of specific cardioprotective properties of ACE inhibition by perindopril in addition to the blood pressure-lowering effects, such as anti-atherosclerotic, anti-inflammatory and antithrombotic properties. In addition, the observed consistency of the treatment benefit across subgroups indicates that the absolute benefits conferred by treatment are mainly established by each patient's future risk of vascular complications, rather than their initial blood pressure level or other risk factors. This article describes these issues according to the main studies with perindopril or perindopril-based regimens, concluding that the blood pressure-dependent and -independent cardioprotective effects extend to all patients with vascular disease. This concept supports the provision of ACE inhibitor-based treatment, not on the basis of arbitrary cut-off points for blood pressure but rather on assessment of vascular risk, which is raised in patients with stable CAD, diabetes and stroke. SN - 1744-8344 UR - https://www.unboundmedicine.com/medline/citation/19379059/Angiotensin_converting_enzyme_inhibition_by_perindopril_in_the_treatment_of_cardiovascular_disease_ L2 - http://www.tandfonline.com/doi/full/10.1586/erc.09.2 DB - PRIME DP - Unbound Medicine ER -