Efficacy and acceptability of perindopril in essential hypertension.

The clinical efficacy and acceptability of once-daily perindopril (4 to 8 mg) monotherapy and in combination with hydrochlorothiazide (50 mg/day) was studied in mild to moderate stable essential hypertensive patients in 4 centres in Thailand. After 2-4 weeks of placebo run-in period, patients received active treatment for 3 months starting with 4 mg perindopril once daily. Dose titration was at second and third month of active treatment if the supine DBP was > 90 mmHg. The dose was doubled and if necessary, 50 mg/day hydrochlorothiazide was added in the last month. The results in 95 patients showed that the mean reduction in supine SBP/DBP at 1, 2 and 3 months of treatment was 10.3/8.0, 13.2/8.7 and 19.1/13.7 mmHg respectively. At the end of the study, 80 per cent of the patients showed normalisation of the supine diastolic blood pressure (supine DBP < or = 90 mmHg) with 30 per cent receiving combined therapy of perindopril and hydrochlorothiazide. There was no significant change in routine haematology or serum biochemistry except for slight increase of potassium levels in patients receiving 8 mg perindopril monotherapy. The incidence of side effects and withdrawal from treatment were quite low. Cough was the major side effect reported comprising 13.6 per cent with only 1 case withdrawn. The study confirms the previous studies that perindopril had satisfactory antihypertensive efficacy and acceptability profiles.

Early response of hyperlipidemic subjects to simvastatin.

Seventy eight patients with hypercholesterolemia from 4 major hospitals were studied with regard to their responses to an adjustable dose of simvastatin, a HMG-CoA reductase inhibitor. They were followed for up to 6 months with 4 sample points during the drug and 2 prior to therapy. The average dose was 10.2 mg/day (S.D. 5.5). Four were controlled on 5 mg and 4 needed 30 mg per day. Thirty seven per cent had elevated serum transaminases but none to greater than twice normal. Only a third of these showed elevation of transaminases during drug therapy alone. The mean total cholesterol (TC) was 304 mg/100 ml and low density lipoprotein (LDL) was 221 mg/100 ml. These fell 70 and 60 per cent respectively and over 90 per cent of the patients reduced their TC and LDL more than the limits defined from previous long term monitoring of patients (i.e. TC fell by more than 17% and LDL by 25%). High density lipoprotein, HDL, started off at 45 mg/100 ml and rose to an average of 115 per cent. Triglyceride, TG, started off at 207 mg/100 ml and fell to about 86 per cent during simvastatin. However, in terms of the proportion of patients who responded greater than the limit previously determined (i.e. more than a 25% change for HDL and 45% for TG), only about 20 per cent significantly responded with elevation of HDL and 13 per cent dropped their TG. The response of TG was more marked at TG greater than 300 mg/100 ml.