Antihypertensive Efficacy and Safety of Perindopril Versus Nifedipine in High Salt Intake Essential Hypertensives : A Double-Blind Parallel Group Study

ABSTRACT

BACKGROUND: To assess the efficacy and safety of perindopril, a new angiotensin-converting enzyme(ACE) inhibitor, perindopril was compaired to nifedipine LP. METHODS: Perindopril(4mg q.d.) was compaired to nifedipine LP(20mg b.i.d.) in the double blind, parallel-group study involving total of 41 hypertensive patients with diatolic blood pressure(DBP) of 95-125mmHg. A 4-week single-blind placebo period preceeded 12 weeks of active tratment. Dose titration was at weeks 4 and 8 if the DBP was >90mmHg. The dose was doubled and, if necessary, a diuretic(hydrochlorthiazide 25mg) was added. The analysis of efficacy was performed on the 36 patients who completed the trial after 12 weeks; active treatment. The analysis of tolerance involved all 41 patients who entered the study. RESULTS: 1) The two groups were homogeneous prior to treatment. 2) The fall in blood pressure(BP) with perindopril was 22/11mmHg(from 160+/-14/101+/-6mmHg to 139+/-15/90+/-6mmHg) and 32/19mmHg(from 164+/-18/104+/-7 to 132+/-17/85+/-10mmHg) for nifedipine. 3) 65% of the perindopril group and 84% of the nifedipine group achived the target BP(diastolic BP or =10mmHg) was similar between two groups(88% cersus 89%). 5) Heart rate was not changed in the perindopril group. but increased in the nifedipine group. 6) Five patients withdrew from the study ; two were attributed to adverse events. one in the perindopril group and one in the nifedipine group. 7) The incidence of side effects in the perindopil group was less than that in the nifedipine group. Cough was reported by 10% of patients of the perindopril group. 8) Both groups did not induce changes in blood glucose and lipid profiles. 9) We could not find any significant relationship between the amount of blood pressure decline and 24 hour urine sodium excretion. 10) There were no clinically significant changes in laboratory parameters. CONCLUSION: Perindopril reduced blood pressure to slightly less extent than nifedipine, but had as similar efficacy as nifedipine. Perindopril had less side effects than nifedipine.