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Актуальність. Лікування артеріальної гіпертензії у хворого з абдомінальним ожирінням є дуже складною задачею. Тому найбільш доцільнім вважається застосування для лікування цієї категорії хворих комбінованої антигіпертензивної терапії з використанням двох і більше компонентів. Метою дослідження було вивчення клінічної ефективності фіксованої комбінації периндоприлу, індапаміду, амлодипіну у хворих на артеріальну гіпертензію в поєднанні з абдомінальним ожирінням. Матеріали і методи. Обстежені 32 хворі на неконтрольовану артеріальну гіпертензію з абдомінальним ожирінням у динаміці 12-тижневої терапії фіксованою трикомпонентною комбінацією — периндоприл/індапамід/амлодипін на тлі застосування аторвастатину і дієтичних рекомендацій. Результати. Показано, що використання фіксованої трикомпонентної комбінації — периндоприл/індапамід/амлодипін на тлі середньодозової статинотерапії і дієтичних рекомендацій у хворих на неконтрольовану артеріальну гіпертензію з абдомінальним ожирінням супроводжується позитивними змінами рівнів ліпідів крові і не викликає погіршення показників вуглеводного і пуринового обмінів. Висновки. Установлена висока ефективність апробованої фіксованої трикомпонентної комбінації антигіпертензивних препаратів у цієї категорії хворих.

Introduction To assess real-life effectiveness of a perindopril/indapamide (Per/Ind) single-pill combination (SPC) in patients with hypertension (HT) and type 2 diabetes mellitus (T2DM), obesity and/or metabolic syndrome (MetS). Methods This post hoc analysis pooled raw data from four large observational studies (FORTISSIMO, FORSAGE, ACES, PICASSO). Patients, most with uncontrolled blood pressure (BP) on previous treatments were switched to Per/Ind (10 mg/2.5 mg) SPC at study entry. Office systolic and diastolic blood pressures (SBP and DBP) were measured at baseline, 1 month and 3 months. Results In the overall pooled population (N = 16,763), mean age was 61 ± 12 years, HT duration 11 ± 8 years, and baseline SBP/DBP 162/94 mmHg. T2DM, obesity and MetS were present in 21%, 49% and 27% of patients, respectively. Subgroups had similar mean age and HT duration to the overall population; patients with T2DM were slightly older (64 ± 10 years) with a longer HT duration (13 ± 8 years). Mean BP was approximately 160/95 mmHg in each subgroup. At 1 month, mean SBP decreased by approximately 20 mmHg in the overall population, and by a further 10 mmHg at 3 months. Similar results were observed in the three subgroups, with mean changes from baseline at 3 months of − 28 ± 15/− 13 ± 10 in T2DM; − 30 ± 15/− 14 ± 10 in obesity; and – 31 ± 15/− 15 ± 9 mmHg in MetS. BP decreases were greatest in patients with grade II or grade III HT. BP control rates (

Our objective was to determine the effectiveness of a perindopril/indapamide (Per/Ind) single-pill combination (SPC) in a broad range of patient profiles, including subgroups with varying hypertension severity, age and cardiovascular risk profiles. Patient data from four large prospective observational studies (FORTISSIMO, FORSAGE, PICASSO, ACES) were pooled. In each study, patients already treated for hypertension were switched to Per/Ind 10/2.5 mg SPC and systolic and diastolic blood pressure (SBP/DBP) measured at the 1-month (M1) and 3-month (M3) visits. Study endpoints included change in SBP and DBP from baseline to M1 and M3 and the percentage of patients achieving BP control (SBP/DBP

The relationship between blood pressure (BP) and cerebral blood flow (CBF) is not fully understood. This study evaluated the impact of a perindopril arginine/indapamide (Pa/I) single-pill combination (SPC) on CBF in middle-aged patients. A total of 22 treatment-naive patients with essential hypertension and at least one hypertension-mediated organ damage and 41 healthy controls were enrolled. At baseline, all participants underwent brain magnetic resonance imaging (MRI); patients with hypertension underwent an additional MRI at end of follow-up. Arterial spin labeling (ASL) was used to calculate CBF in the frontal lobe cortical plate. Patients with hypertension received once-daily Pa/I 5 mg/1.25 mg SPC, which could be increased to Pa/I 10 mg/2.5 mg at 2 weeks if necessary. Patients with hypertension underwent 24-h ambulatory BP monitoring (ABPM) at baseline and end of follow-up. Mean baseline BP values were 146.2/93.1 and 119.1/76.1 mmHg in the hypertension and control groups, respectively. Patients with hypertension had significantly (p

A simple, rapid, mass compatible, selective, stability-indicating ultra high performance liquid chromatographic method was developed for the simultaneous estimation of Perindopril (PER), Indapamide...

Background: Arterial hypertension (AH) remains the most common cardiovascular (CV) risk factor worldwide. Methods: Seventy five moderate-to-severe hypertensive patients with abdominal obesity aged from 48 to 66 years (45/30 men and women respectively) were selected from the entire cohort (n = 375) according to the inclusion and exclusion criteria. The patients were divided into two subgroups depending on the arm of antihypertensive therapy lines. The first subgroup of patients (n = 36) received a non-fixed combination of oral antihypertensive agents: perindopril (4–8 mg daily), indapamide (1.25–2.5 mg daily) and amlodopine (5–10 mg daily). The second subgroup of patients (n=39) received fixed-dosed combination of these antihypertensive agents aforementioned in the ranged doses (4 mg/1.25mg/5 mg; 4 mg/1.25mg/10 mg; 8 mg/2.5 mg/5 mg; 8 mg/2.5mg/10 mg) in the same manner. The examinations of the clinical status, office, and ambulatory blood pressure values were carried out at baseline in 3 and 6 months after study entry. Results: The frequencies of BP target levels after treatment were higher in the fixed-dose combination group than in the non-fixed combination (at 3 months: 80% versus 58%, p

Most patients with arterial hypertension (AH) for successful long-term blood pressure (BP) control require combination of antihypertensive drugs acting on various target organs. Accumulated experience shows that about 30 % of patients require combination therapy with 3 drugs from different pharmacological classes. Efficacy of BP control in real clinical practice with the use of various doses of perindopril, indapamide, and amlodipine as components of taken once-daily triple fixed combination was assessed in the 3-months prospective observational open-label PETRA study. In this study data of office BP measurements and 24-hour ambulatory BP monitoring (ABPM) were obtained from 11209 ambulatory patients (47.6 % women) with AH. Initial mean office BP (BPmoff) was 156.58±16.10 / 91.56±9.33 mm Hg, AH duration – 9.48±7.19 years. After switching to triple fixed dose combination of perindopril, indapamide, and amlodipine BPmoff decreased by 24.81±15.47 / 11.41±9.90 mm Hg (p

Background Most antihypertensive drugs used in monotherapy or in combination therapy reduce the left ventricular mass index (LVMI). However, little is known about the effects on LVMI of a triple fixed-dose combination (TFC) therapy, containing in a single pill an angiotensin-converting enzyme inhibitor (ACEI), a diuretic and a calcium channel blocker (CCB). Methods In this prospective open-label study, 92 patients with essential hypertension were randomized to treatment with a TFC of perindopril/indapamide/amlodipine at different doses or a triple free combination therapy (FCT) including ACEI/diuretic/CCB. Office blood pressure (BP) measurement, 24 h-ambulatory BP monitoring and echocardiography were performed at baseline and during a 14-month follow-up. The BP variability (BPV) over 24 h was calculated as ± standard deviation of the daytime systolic BP. Differences between office and monitored BP and LVMI were evaluated by ANOVA for repeated measures. Results A significant BP-lowering effect was observed for both treatments. At follow-up, BPV was reduced in both the treatment groups vs. the baseline (14.0 ± 1.5 vs. 17.0 ±1.8 and 16.2 ± 2.1 vs. 17.6 ± 2.3, respectively), but it was lower in the TFC vs. the FCT group (14.0 ± 1.5 vs. 16.1 ± 2.2, P < 0.05). LVMI was lower in both the treatment groups, but the change was greater for TFC vs. FCT (−8.3 ± 4.9% vs. −2.0 ± 2.1%, P < 0.0001). Left ventricular hypertrophy (LVH) regression was greater in the TFC vs. the FCT group (43.5% vs. 30.4%, P < 0.05). Conclusions Independently of BP values achieved, the antihypertensive TFC therapy was more effective than FCT in LVMI reduction and LVH regression, possibly related to drugs’ intrinsic properties and to BPV modulation.

In everyday medical practice, physicians often need to manage patients whose blood pressure is not well controlled. Those with a history of cerebrovascular disease are a high-risk group in need of rapid blood pressure control. The PICASSO study was a real-life, observational trial involving 9257 inadequately treated hypertensive patients who were switched from previous therapy to the fixed-dose combination of perindopril 10 mg/indapamide 2.5 mg (PI) for 3 months. A subanalysis of data of 1117 hypertensive patients who met the clinical criteria of previous stroke or transient ischemic attack was performed. Twenty-four hour ambulatory blood pressure measurements (ABPMs) were also done in a small group of patients (n:38). At baseline, mean systolic/diastolic blood pressure (SBP/DBP) was 161.5 ± 15.2/93.1 ± 9.9 mmHg. After 1 month with the fixed dose of PI, average office SBP/DBP decreased to 140.0 ± 11.9/83.5 ± 7.7 mmHg. After 3 months, SBP/DBP had dropped to 132.9 ± 9.8/80.0 ± 6.2 mmHg, by 28.6 ± 15.5/13.1 ± 10.0 mmHg (p

This 4-month, double-blind, randomized, controlled trial was designed to demonstrate the superiority of perindopril/indapamide/amlodipine single pill over perindopril/indapamide after 1 month and to determine further up-titration efficacy and safety in patients with mild-to-moderate hypertension. After a 1-month run-in period on perindopril/indapamide 5/1.25 mg, patients with SBP/DBP at least 150/95 mmHg and no diabetes or renal insufficiency received perindopril/indapamide/amlodipine 5/1.25/5 mg single pill or continued on the same treatment. At 1, 2, and 3 months, patients with uncontrolled blood pressure (SBP/DBP ≥ 140/90 mmHg) were gradually up-titrated with a higher dose of the triple therapy up to perindopril/indapamide/amlodipine 10/2.5/10 mg in both groups. Efficacy was assessed on office supine SBP (main criterion) and DBP, blood pressure control, and response rates. Treatment effect on ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM) parameters was also assessed in two subpopulations of 276 and 263 patients, respectively. A total of 454 hypertensive patients (diabetes and renal insufficiency excluded) were randomized, 227 to each group (56% were men, mean age was 55 years, blood pressure 162.3/101.1 mmHg). After 1 month, superior SBP (−3.1 mmHg, P = 0.02) and DBP (−2.8 mmHg, P

The etiology of essential hypertension is multifactorial. Therefore, treatment with combinations of antihypertensive agents acting on multiple targets is necessary for successful therapy in the majority of patients. According to the experience and clinical data accumulated so far, combination therapy with three agents from different pharmacological classes is required in approx. 30% of patients in order to achieve long-term blood pressure control. The primary objective of the PETRA study was to evaluate the efficacy of blood pressure (BP) control with once daily administration of the different dosage strengths of the once-daily, triple fixed combination of perindopril, indapamide, and amlodipine. The evaluation was based on office BP readings and ambulatory blood pressure monitoring (ABPM) data gathered in routine clinical practice. Data from 11,209 hypertensive patients (the proportion of female subjects was 47.6%) were processed and interpreted in a 3-month-long prospective, observational, non-interventional, open-label study conducted in 997 centers in Hungary. Mean baseline office BP was 156.58 ± 16.10/91.56 ± 9.33 mmHg (mean ± SD), whereas the mean duration of hypertension was 9.48 ± 7.19 years. Mean office BP decreased by 24.81 ± 15.47/11.41 ± 9.90 mmHg after switching to the triple fixed combination of perindopril, indapamide, and amlodipine (p

The management of patients with arterial hypertension is a difficult problem even if use the modern antihypertensive drugs. The reasons of the inadequate control to arterial pressure level during the treatment are different. The application fixed combinations of antihypertensive drugs improves the results of therapy, weigh with separate pathogenetic mechanisms of blood pressure increasing and the counterregulatory effects of the treatment each components of the combination. The use of fixed combinations significantly increases patient adherence to treatment. A new fixed triple combination of perindopril, indapamide, amlodipine expands therapeutic options for the treatment arterial hypertension. The effectiveness of the use of each of the components and their combination is proved in large international studies.

Aim . To study the antihypertensive and hypolipidemic effect of a group of drugs including perindopril,rosuvastatin and fixed-dose combination of perindopril and indapamide, in ambulatory patients with hypertension and dyslipidemia. Material and methods . Analysis of the medical data of patients treated with perindopril, indapamide and rosuvastatin in the multicenter, non-interventional study (SYNERGY) was performed. Patients had a diagnosis of hypertension and dyslipidemia, determined in routine clinical practice. Therapy was prescribed to patients in various dosing regimens. The data of anamnesis, physical status, blood pressure measurements, lipid levels were taken from the patient's medical records. The safety assessment was also performed. The duration of follow-up was 8 weeks. Results . A total of 1383 patients were included into the analysis, 53.5% (n=740) of women and 46.5% (n=643) of men. The average age was 55.8 years. 914 patients (66.1%) had previously received antihypertensive therapy, and 439 (31.7%) had previously received lipid-lowering therapy. A significant reduction in the levels of systolic (SBP), diastolic BP (DBP), and low-density lipoprotein cholesterol (LDL-c) was found at the end of the study in all study groups (p

Despite the overwhelming evidence and the established benefits of antihypertensive treatment, adherence to treatment remains low. To assess the adherence to treatment with a perindopril/indapamide/amlodipine single-pill combination (SPC), its effectiveness on blood pressure (BP) reduction, as well as the safety and tolerability of this SPC over a 4-month treatment period. This multicenter, non-interventional study prospectively included 2285 hypertensive patients on perindopril/indapamide/amlodipine SPC. The data were recorded at baseline, 1 month, and 4 months. Of the 2285 hypertensive patients included in the study, 50.5% were at “high/very high risk”. Mean systolic (SBP)/diastolic (DBP) decreased from 162.3 ± 13.3/93.1 ± 9.3 mmHg at baseline to 129.7 ± 8.3/78.6 ± 7.1 mmHg at 4 months (p

Poor blood pressure (BP) control contributes to complications in sub-Saharan African (SSA) type 2 diabetic individuals. Experts have advocated the use of combination therapies for effective BP control in these patients. The suggested combinations should include a RAAS antagonist and either a CCB or a thiazide diuretic; however, their efficacy is yet to be established in SSA. We investigated the short-term effects of two combination therapies on BP control in SSA type 2 diabetic individuals. This was a double-blinded randomized controlled trial conducted at the Yaounde Central Hospital (Cameroon) from October 2016 to May 2017. We included type 2 diabetic patients, newly diagnosed for hypertension. After baseline assessment and 24-hour ABPM, participants were allocated to receive either a fixed combination of perindopril + amlodipine or perindopril + indapamide for 42 days. Data analyses followed the intention-to-treat principle. We included fifteen participants (8 being females) in each group. Both combinations provided good circadian BP control after 6 weeks with similar efficacy. Twenty-four-hour SBP dropped from 144 to 145 mm Hg vs 128 to 126 mm Hg with perindopril-amlodipine and perindopril-indapamide, respectively (P = 0.003 for both groups). Twenty-four-hour DBP dropped from 85 to 78 mm Hg (P = 0.013) vs 89 to 79 mm Hg (P = 0.006) in the same respective groups. No significant adverse effect was reported. A fixed initial combination of perindopril-amlodipine or perindopril-indapamide achieved similar effective BP control after 6 weeks in SSA type 2 diabetic individuals with newly diagnosed hypertension. Therefore, these combinations can be used interchangeably in this indication.

The study objective was to evaluate the ability of the fixed combination (FC) of perindopril + indapamide (P+I) to reduce insulin resistance and low intensive noninfectious inflammation as well as to improve arterial elasticity in patients with hypertension, obesity and prediabetes on previous successful antihypertensive therapy with losartan + hydrochlorothiazide (L+HTZ) 100/12.5 mg. A 12-week open-label study included 50 patients (age 54.8 ± 6.6 years, body mass index (BMI) 32.5 ± 3.2 kg/m2). All patients underwent a 24-hour ambulatory blood pressure monitoring, applanation tonometry (assessment of augmentation index (AI), central blood pressure (CBP)), pulse wave velocity (PWV) measurement and laboratory investigations (lipid profile, fasting glucose, the homeostatic model assessment (HOMA) index, homocysteine, leptin, adiponectin, high-sensitive C-reactive protein (hsCRP)). Results: The switch of patients from L+HTZ to a FC of P+I resulted in an additional decrease in systolic BP and diastolic BP by 3.9% and 5.4%, respectively (p Conclusions: FC of P+I is superior to the L+HTZ in BP control, improvement of arterial elasticity and promotes a decrease in BMI, suppression of insulin-resistance and low intensive noninfectious inflammation in patients with hypertension, associated obesity and prediabetes. Disclosure S.V. Nedogoda: None. I. Barykina: None. A. Salasyuk: None. V.O. Smirnova: None. E. Popova: None.

Hypertension has a major associated risk for organ damage and mortality, which is further heightened in patients with prior cardiovascular events, comorbid diabetes mellitus, microalbuminuria and renal impairment. Convers Plus tablet including perindopril erbumine (PE), which is an angiotensin converting enzyme (ACE) inhibitor, and indapamide, which is diuretic, was designed as a combined tablet to succes in the treatment of hypertension. Physico-pharmaceutical properties and characterization studies were evaluated in vitro conditions. Later on in vivo study was planned as a cross-designed, randomized, open-labeled, single-dose, single-center study via peroral route in 24 healthy male subjects. In this study, bioequivalence with primary pharmacokinetical target parameters reference (Bipreterax 4/1.25 mg Tablet-S.A.Servier Benelux N.V.) and test (Convers Plus 4/1.25 mg Tablet-ARGESAN Pharmaceutical Company) tablets have been found bioequivalent. The results of pharmacokinetic parameters for perindopril, perindoprilat and indapamide were found as Cmax = 23.179 µg/mL, tmax = 0.729 h, t1/2 = 1.429 h; AUC0-t = 26.998 µgs/mL, AUC0-inf = 27.117 µgs/mL; Cmax = 1.834 µg/mL, tmax = 8.792 h, t1/2 = 40.699 h; AUC0-t = 54.828 µgs/mL, AUC0-inf = 77.113 µgs/mL; Cmax = 18.994 µg/mL, tmax = 3.417 h, t1/2 = 16.626 h and AUC0-t = 385.829 µgs/mL, AUC0-inf = 410.728 µgs/mL respectively. In conclusion, physico-pharmaceutical properties and results of clinical trials show that Convers Plus tablets have been found as bioequivalent for perindopril, perindoprilat and indapamide in terms of AUC and Cmax, in 90% confidence limits.

Our objective was to evaluate a triple-drug antihypertensive strategy for blood pressure control in patients with difficult-to-treat hypertension. The Perindopril-Indapamide plus AmlodipiNe in high rISk hyperTensive patients (PIANIST) trial was an observational, 4-month, open-label study. A total of 4,731 patients at high or very high cardiovascular risk with hypertension that was not properly controlled despite antihypertensive therapy, and for whom study treatment (fixed-dose perindopril 10 mg/indapamide 2.5 mg + amlodipine 5 or 10 mg) was consistent with their existing therapeutic plan, were included. One-sample t tests and Chi-squared tests were performed to evaluate changes in blood pressure. Mean baseline office blood pressure (OBP) was 160.5 ± 13.3/93.8 ± 8.7 mmHg. After 4 months of therapy, OBP decreased by 28.3 ± 13.5/13.8 ± 9.4 to 132.2 ± 8.6/80.0 ± 6.6 mmHg (p

Background Hypertension and type 2 diabetes mellitus (T2DM) synergistically deteriorate the vascular environment, making blood pressure reduction challenging, and substantially increasing cardiovascular risk. Methods In the real-life, open-label, observational, PICASSO study, 9,257 hypertensive patients unsuccessfully treated with antihypertensives were switched to fixed-dose combination of perindopril 10 mg/indapamide 2.5 mg. In this subgroup analysis, we analyzed changes in blood pressure and laboratory parameters of 2,762 hypertensive patients with T2DM or pre-diabetes. Results After 3 months of treatment, significant decreases in office blood pressure were noted in the whole cohort (−27.0 ± 14.8/−12.7 ± 9.8 mmHg; p

Blood pressure (BP) control in hypertensive patients remains poor worldwide, particularly in high-risk patients with hypertension and diabetes. Guidelines recommend that such patients receive prompt pharmacological therapy at maximal doses to rapidly control BP. We aimed to evaluate efficacy and safety of single-pill combination (SPC) perindopril/indapamide (PER/IND) at full dose (10/2.5 mg) in hypertensive patients, including diabetics, with BP uncontrolled by previous medication.Twelve-week prospective, observational study in patients with uncontrolled hypertension (≥160-200 mmHg systolic BP [SBP] and110 mmHg diastolic BP [DBP]) on a previous SPC or free-dose combination of renin-angiotensin system blocker plus thiazide diuretic, substituted with PER/IND 10/2.5 mg. Office BP, quality of life, and blood parameters were evaluated in the whole cohort and patients with type 2 diabetes mellitus.2120 ambulatory hypertensive patients were enrolled, including 307 with type 2 diabetes. Two weeks after substitution, SBP significantly decreased from 171.0 ± 13.3 to 148.6 ± 13.4 mmHg, and DBP from 98.6 ± 8.3 to 88.8 ± 7.9 mmHg (both p 0.00001). A similar rapid decrease was noted in the diabetes subgroup. After 12 weeks, BP had reduced by 42/19 mmHg in the whole cohort (diabetes subgroup: 41/18 mmHg). Most (84%; diabetes subgroup: 77%) patients reached BP target (140/90 mmHg). Laboratory tests and quality of life improved in the whole cohort and the diabetic subgroup.Switching to PER/IND at full dose (10/2.5 mg) was well tolerated, leading to fast BP reduction and control in the majority of patients with uncontrolled hypertension, including difficult-to-treat patients with diabetes.

Objective:Hypertension is worldwide spread and represents the leading cause of death. Diabetes rich epidemic levels in global population. Hypertension and diabetes are frequently present in the same patient and represents independent cardiovascular risk factors. Both hypertension and diabetes are as

Hypertension and type 2 diabetes in combination are associated with a significantly higher level of cardiovascular events. The aim of this prospective study was to evaluate the antihypertensive efficacy and tolerability of single-pill perindopril/indapamide in patients with hypertension and type 2 diabetes. Patients with both hypertension and type 2 diabetes were enrolled in this multicenter, prospective, open clinical study. Single-pill perindopril/indapamide was either prescribed on its own (started or switched to from previous treatment) or added to previous therapy. Perindopril/indapamide dosage could be increased, from 5/1.25 mg to 10/2.5 mg once daily, if blood pressure (BP) was uncontrolled. BP and tolerability were assessed at 4 visits over a 6-month period. Microalbuminuria was assessed at baseline and 6 months in a subgroup. 397 patients were analyzed (age 57.6 ± 9.4 years, men 46 %). At baseline, systolic blood pressure (SBP) was 160.0 ± 14.3 mmHg, diastolic blood pressure (DBP) 95.2 ± 8.3 mmHg, and pulse pressure 64.8 ± 12.7 mmHg. Nearly half (45 %) of patients received perindopril/indapamide alone and 55 % added this single-pill combination to existing therapy. After 6 months, SBP fell by 30 mmHg, DBP by 14 mmHg, and pulse pressure by 16 mmHg (all p

BACKGROUND: The Action in Diabetes and Vascular Disease (ADVANCE) Study demonstrated that a fixed combination of perindopril and indapamide reduced the risk of major vascular events and mortality in patients with type 2 diabetes. This Echocardiographic Substudy was designed to determine the effects of this treatment on left ventricular diastolic function and left ventricular mass. METHODS: Five hundred and fifty-five patients entering ADVANCE underwent quantitative echocardiography prior to randomization and after 6 months and 4 years of treatment with perindopril-indapamide or placebo. Main end points were left ventricular diastolic function (ratio of mitral E velocity/early medial mitral annular tissue Doppler velocity, E/Em, and left atrial volume index) and left ventricular mass index. RESULTS: Overall, blood pressure was reduced in the perindopril-indapamide group compared with placebo. E/Em and left atrial volume index both increased over the 4 years. There was no effect of perindopril-indapamide on E/Em, although there was a small attenuation of the increase in left atrial volume index with active treatment. Left ventricular mass index was reduced by 2.7 g/m with active treatment (95% confidence interval -5.0 to -0.1, P = 0.04). CONCLUSION: Compared with placebo, the perindopril-indapamide combination reduced blood pressure and left ventricular mass in patients with diabetes, but did not improve left ventricular diastolic function. Left ventricular diastolic function worsened in both groups over 4 years, despite blood pressure reduction and reduction in left ventricular mass. Improving left ventricular diastolic function remains a challenge in patients with diabetes.

Perindopril/indapamide combination has been shown to reduce cardiovascular risk in different groups of patients. A total of 18,529 patients (9,272 receiving perindopril/indapamide and 9,257 receiving placebo) were included in this meta-analysis involving three large randomized clinical trials-ADVANCE, PROGRESS and HYVET. A non-significant reduction in fatal and non-fatal stroke was seen (Odds ratio 0.73; 95% Confidence Interval 0.49 to 1.09; z=1.52 and p= 0.13). The combination was associated with a significantly reduction of vascular death (Odds ratio 0.79; 95% Confidence Interval 0.69 to 0.90; z=3.48 and p=0.0005) and major cardio-vascular events (Odds ratio 0.72; 95% Confidence Interval 0.53 to 0.97; z=2.15 and p= 0.03). Fixed-combination of Perindopril and indapamide substantially reduced major cardiovascular event and vascular death. However, effect on stroke needs further evaluation.

BACKGROUND Microvascular rarefaction and endothelium dysfunction are hallmarks of hypertension. We assessed whether antihypertensive treatments affect the microcirculation and whether the fixed-dose combination perindopril/indapamide (per/ind) modifies the microcirculation of hypertensive patients independently of blood pressure reduction. METHODS One hundred ninety-three consecutive patients were enrolled into one of four groups depending on their blood pressure and existing treatment: (i) controlled hypertensive patients treated with per/ind (controlled-per/ind), (ii) controlled hypertensive patients treated with agents other than angiotensin-converting enzyme (ACE) inhibitors or diuretics (controlled-other), (iii) uncontrolled hypertensive patients treated with agents other than ACE inhibitors or diuretics (uncontrolled-other), (iv) untreated normotensive subjects. Macro- and microcirculation parameters were evaluated once in every patient. We used intravital video microscopy to measure dermal capillary density in the dorsum of the fingers. Microvascular endothelial function was assessed by measuring the perfusion increases after pilocarpine iontophoresis and central hemodynamic parameters by tonometry. RESULTS Capillary density was significantly higher in controlled-per/ind patients (99 ± 12 capillaries/mm(2)) than in all other groups (P < 0.05). Controlled-per/ind patients had a significantly greater endothelial response to pilocarpine than patients from all other groups (P < 0.05). Central hemodynamic parameters were similarly improved in both controlled groups compared with the uncontrolled-other group (P < 0.05). CONCLUSIONS Thus, hypertensive patients with blood pressure controlled with the combination per/ind had normalized capillary density and endothelial function, whereas other antihypertensive treatments, excluding ACE inhibitors or diuretics, had less effect despite similar blood pressure control.

The increase in type 2 diabetes mellitus is associated to cardiovascular morbidity and mortality. This review focuses on the benefits of the fixed-dose combination of perindopril and indapamide on cardiovascular and renal end points in the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation) trial.In the last decade, clinical trials have indicated that blood pressure reduction and glucose lowering were effective in reducing morbidity and morbility. The ADVANCE trial has explored both intensive glucose lowering with gliclazide modified release (MR) and intensive blood pressure lowering using a fixed combination of perindopril/indapamide, on top of current treatments, including renin-angiotensin inhibitors.In ADVANCE, perindopril/indapamide reduced a composite of macrovascular and microvascular events, also significantly decreasing cardiovascular mortality and death from any cause and reducing coronary and renal complications. The review discusses the relevance of results and the advantages of this therapeutic strategy in clinical practice.ADVANCE provides a new, simple and pragmatic treatment algorithm that maximizes clinical benefits and is suitable for all type 2 diabetic patients: intensive blood pressure lowering based on combined perindopril/indapamide with intensive glucose lowering based on gliclazide MR.

Despite the widespread notion that controlling hypertension is essential to improve cardiovascular outcome, uncontrolled hypertension rates remain high. Fixed-dose combinations are used routinely to reduce the impact of hypertension. Treatment with fixed-combination perindopril/indapamide, for example, at the currently approved doses (perindopril 2 mg/indapamide 0.625 mg [Per2/Ind0.625] and perindopril 4 mg/indapamide 1.25 mg [Per4/Ind1.25]), reduces blood pressure, end-organ damage, and cardiovascular morbidity and mortality in a wide range of hypertensive patients.This article reviews three published randomised trials that evaluated the efficacy and safety of the highest dose of perindopril/indapamide (perindopril 8 mg/indapamide 2.5 mg [Per8/Ind2.5]) in blood pressure lowering and end-organ protection studies.In the first (dose-finding) study, incremental reductions in SBP/DBP were observed with each dose doubling. After 8 weeks of treatment, decreases in supine SBP/DBP were statistically significant compared to placebo for all three doses, with incremental and progressive reductions with each dose doubling: ranging from SBP/DBP respectively -14/-9 mmHg for Per2/Ind0.625 to -23/-15 mmHg for Per8/Ind2.5 compared to -5/-5 mmHg for placebo. In the PICXEL and PREMIER trials, SBP/DBP decreases of 16.3/8.1 mmHg (p0.0001) and 2.5/2.6 mmHg, respectively, were noted when Per4/Ind1.25 was doubled to Per8/Ind2.5 (decreases from 167.7/101.7 to 151.4/93.6 in PICXEL and from 154.9/92.1 to 152.4/89.5 in PREMIER, respectively). As a consequence more patients had normalised blood pressure (22% and 17%), more patients responded to treatment (68% and 45%), and 29% and 10% of non-responders became responders, in PICXEL and PREMIER, respectively. Additional end-organ benefits were also noted with Per8/Ind2.5. In PICXEL, significant decreases from baseline in left ventricular mass were noted with all three doses, with a 17.5 g/m(2) decrease from baseline in patients whose maximum dose was Per8/Ind2.5 (from 148.5 g/m(2) +/- 39.5 (mean +/- SD) to 131 g/m(2); p0.0001). In PREMIER, changes in albumin excretion rate were also noted with all three doses, with a 45% reduction from baseline in patients whose maximum dose was Per8/Ind2.5 (p0.0001). When safety data, including potassium levels, were analysed, the increase in dose to Per8/Ind2.5 did not have a notable impact on the safety profile of perindopril/indapamide.Based on data available from an evaluation of three randomised clinical trials, fixed-combination Per8/Ind2.5 provided a significant, incremental reduction in blood pressure as well as cardiac and renal end-organ protection while remaining safe and well-tolerated.

Aim: to evaluate blood pressure (BP) lowering rates in 3 subgroups of hypertensive patients in 3 different clinical situations in which Noliprel and if necessary Noliprel forte may be recommended. Results. In 4 wks of treatment SBP mean values were significantly reduced from 158±19 mm Hg to 131±11mm Hg (p

Contains fulltext : 81639.pdf (Publisher’s version ) (Closed access) AIMS: The aim of this study was to investigate serious clinical outcomes associated with atrial fibrillation (AF) and the effects of routine blood pressure lowering on such outcomes in the presence or absence of AF, among individuals with type 2 diabetes. METHODS AND RESULTS: About 11 140 patients with type 2 diabetes (7.6% of whom had AF at baseline) were randomized to a fixed combination of perindopril and indapamide or placebo in the Action in Diabetes and Vascular Disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study. We compared total mortality and cardiovascular disease outcomes and effects of randomized treatment for 4.3 years on such outcomes between patients with and without AF at baseline. After multiple adjustments, AF was associated with a 61% (95% confidence interval 31-96, P < 0.0001) greater risk of all-cause mortality and comparable higher risks of cardiovascular death, stroke, and heart failure (all P < 0.001). Routine treatment with a fixed combination of perindopril and indapamide produced similar relative, but greater absolute, risk reductions for all-cause and cardiovascular mortalities in patients with AF, compared with those without AF. The number of patients needed to be treated with perindopril-indapamide for 5 years to prevent one cardiovascular death was 42 for patients with AF and 120 for patients without AF at baseline. CONCLUSION: Atrial fibrillation is relatively common in type 2 diabetes and is associated with substantially increased risks of death and cardiovascular events in patients with type 2 diabetes. This arrhythmia identifies individuals who are likely to obtain greater absolute benefits from blood pressure-lowering treatment. Atrial fibrillation in diabetic patients should be regarded as a marker of particularly adverse outcome and prompt aggressive management of all risk factors.

OBJECTIVES ADVANCE was planned to investigate the effects of routine blood pressure lowering with the fixed combination perindopril-indapamide on major vascular events in people with type 2 diabetes, irrespective of initial blood pressures or the use of other blood pressure-lowering drugs, including angiotensin-converting enzyme inhibitors. METHODS A total of 11140 individuals with type 2 diabetes were randomly assigned to fixed combination perindopril-indapamide or matching placebo, after a 6-week run-in period. The primary outcomes were composites of major macrovascular and major microvascular events, analysed jointly and separately, by intention to treat. RESULTS Active treatment reduced blood pressure by 5.6/2.2 mmHg compared with placebo and the relative risks of all deaths, cardiovascular deaths and major vascular events, by 14% (P = 0.025), 18% (P = 0.027) and 9% (P = 0.041), respectively. There were also reductions in total coronary events (14%; P = 0.02) and total renal events (21%; P < 0.0001). Study treatment was well tolerated, with 73% and 74% of participants who received active treatment and placebo, respectively, still adherent to randomized therapy after an average of 4.3 years of follow-up. CONCLUSIONS Routine treatment with the fixed combination perindopril-indapamide, on top of all concomitant protective therapies, was well tolerated and reduced the risks of death and vascular disease irrespective of the initial level of blood pressure. The results suggest that for every 79 patients so treated, one death would be averted over 5 years.

BACKGROUND: Whether the treatment of patients with hypertension who are 80 years of age or older is beneficial is unclear. It has been suggested that antihypertensive therapy may reduce the risk of stroke, despite possibly increasing the risk of death. METHODS: We randomly assigned 3845 patients from Europe, China, Australasia, and Tunisia who were 80 years of age or older and had a sustained systolic blood pressure of 160 mm Hg or more to receive either the diuretic indapamide (sustained release, 1.5 mg) or matching placebo. The angiotensin-converting-enzyme inhibitor perindopril (2 or 4 mg), or matching placebo, was added if necessary to achieve the target blood pressure of 150/80 mm Hg. The primary end point was fatal or nonfatal stroke. RESULTS: The active-treatment group (1933 patients) and the placebo group (1912 patients) were well matched (mean age, 83.6 years; mean blood pressure while sitting, 173.0/90.8 mm Hg); 11.8% had a history of cardiovascular disease. Median follow-up was 1.8 years. At 2 years, the mean blood pressure while sitting was 15.0/6.1 mm Hg lower in the active-treatment group than in the placebo group. In an intention-to-treat analysis, active treatment was associated with a 30% reduction in the rate of fatal or nonfatal stroke (95% confidence interval [CI], -1 to 51; P=0.06), a 39% reduction in the rate of death from stroke (95% CI, 1 to 62; P=0.05), a 21% reduction in the rate of death from any cause (95% CI, 4 to 35; P=0.02), a 23% reduction in the rate of death from cardiovascular causes (95% CI, -1 to 40; P=0.06), and a 64% reduction in the rate of heart failure (95% CI, 42 to 78; P

Jean-Jacques Mourad1, Dulce Lameira1, Pierre-Jean Guillausseau21APHP, Service de Médecine interne, Hôpital Avicenne, Bobigny, France; 2APHP, Service de Médecine B, Hôpital Lariboisière, et Université Paris, Paris, FranceAbstract: The aim of the observational pharmaco-epidemiological study Optimax II was to seek whether the pre-existence of a metabolic syndrome (MS) defi ned by the NCEP-ATP III criteria impacts blood pressure (BP) control in hypertensive patients receiving a fixed perindopril/indapamide combination therapy. The primary objective of the study was to compare in patients with and without MS the rate of BP control defined as a systolic BP ≤140 mmHg and a diastolic BP ≤90 mmHg. Patients were prospectively included and the follow-up lasted 6 months. The study population consisted of 24,069 hypertensive patients (56% men; mean age 62 ± 11 years; 18% diabetics; mean BP at inclusion 162 ± 13/93 ± 9 mmHg). MS was found in 30.4% of the patients (n = 7322): 35.2% women and 20.1% men. Three therapeutic subgroups were constituted: Group A, previously untreated, received the combination therapy as initial treatment; Group B, previously treated but with unsatisfactory results and/or treatment intolerance, had its previous treatment switched to perindopril/indapamide; and Group C, previously treated, with good treatment tolerance but uncontrolled BP, received the study treatment in adjunction to the previous one. The normalization rate was 70.3% in group A, 68.4% in Group B, and 64.1% in Group C (p < 0.0001). The pre-existence of MS did not show any significant influence on these rates since BP lowering was –22.7 ± 13.7 (SBP) and –12.0 ± 10.0 mmHg (DBP) in patients without MS and –22.6 ± 13.3 (SBP) and −12.1 ± 9.7 (DBP) in those with MS. The results of this study show a significant effect of perindopril/indapamide treatment on systolic BP lowering, whatever the treatment status: initiation, switch, or adjunctive therapy, and independently from the presence or not of MS. This effect may be related to the specific vascular effect of the perindopril/indapamide combination, which has recently demonstrated in the ADVANCE trial its ability to reduce mortality, and cardiovascular and renal complications in diabetic patients.Keywords: hypertension, metabolic syndrome, combination therapy, antihypertensive efficacy

In the new millennium, high blood pressure and diabetes are emerging as one of the greatest threats to the health of populations worldwide. The comanagement of diabetes (hemoglobinA1c < 6.5%), and hypertension (blood pressure

Because of the importance of attaining rapid and tight blood-pressure (BP) control, those guidelines that base treatment recommendations on a risk-stratification approach include combination therapies as first-line pharmacologic treatment options. Monotherapies were shown to be ineffective in many patients, and delays in BP control significantly increase the risk of cardiac events, stroke, and death. In diabetic patients in whom BP control is particularly hard to achieve, the use of angiotensin-converting enzyme (ACE) inhibitors, which inhibit the renin-angiotensin system, has been recommended. Consistent with these guidelines, comparative clinical trials confirmed the value of the ACE inhibitor-and-diuretic combination treatment, perindopril/indapamide, in hypertensive diabetic patients and in patients with uncomplicated essential hypertension, multiple risk factors, and associated clinical conditions. Perindopril/indapamide was shown to have an early and sustained effect on systolic BP, and a specific and positive effect on hemodynamics. Treatment attenuates carotid-wave reflections and pulse-wave velocity, both of which are components of pulse pressure and are determinants of left-ventricular afterload, myocardial hypertrophy, and myocardial oxygen consumption. In diabetic patients with albuminuria, perindopril/indapamide treatment significantly reduces BP, the albumin excretion rate, and the urinary albumin:creatinine ratio. The nephroprotective effects of perindopril/indapamide remain significant after adjustment for changes in BP. Together, these data suggest that a combination of perindopril and indapamide, through its effect on BP-lowering and target-organ protection, is suited to the medical needs of a wide range of hypertensive patients, including those with diabetes.

Tight blood pressure (BP) control is required to reduce cardiovascular morbidity and mortality.To evaluate the efficacy and tolerability of the first line combination perindopril/indapamide in hypertension in daily practice.In this prospective, open-label, observational trial, 1892 general practitioners in Germany recruited patients with hypertension (n = 8023; mean age 59.6 years, 48.1% males, body mass index 27.6 kg/m2, systolic BPor= 140 mmHg and/or diastolic BPor= 90 mmHg) between October 2002 and December 2004. Patients received perindopril 2 mg/indapamide 0.625 mg for 12 weeks. BP measured in the general practice setting, safety, and tolerability were evaluated after 4 and 12 weeks.At baseline, most patients had moderate to severe hypertension (78%); initial BP was 164.6/95.8 mmHg. At inclusion, 38% of the patients were newly diagnosed hypertensives (mean BP 166.1/97.2 mmHg) and 58% of patients had uncontrolled BP despite preexisting antihypertensive treatment (163.5/94.9 mmHg). Previous treatment consisted of beta-blockers (49.5%), ACE inhibitors (36.4%), calcium-antagonists (29.3%), diuretics (28.8%), AT-I receptor antagonists (7.1%), and other treatments (8.1%). In the entire study cohort, treatment with perindopril/indapamide significantly decreased systolic BP (27.9 mmHg), diastolic BP (13.7 mmHg), and pulse pressure (14.2 mmHg), compared with baseline (p0.0001); 96% of patients responded to treatment and in 50% of patients BP was normalized (140/90 mmHg). Treatment dose was doubled in 9.5% of patients. Similar results were found in various subgroup analyses (newly diagnosed patients, the elderly, and patients with isolated systolic hypertension, additional cardiovascular risk factors, associated diseases, or target organ damage). The most frequent adverse events (1% of patients) were dry cough and nausea.The open-label, observational study PRIMUS, extends the existing evidence that the first line combination treatment of hypertension with perindopril/indapamide is effective, safe, and well tolerated in a representative cross-section of patients with newly diagnosed or pretreated but uncontrolled hypertension in daily practice.

The study addresses antihypertensive effects of fixed low-dose perindopril-indapamide combination therapy in the elderly hypertensive patients. Combinations with metoprolol were also studied. Is was shown that antihypertensive effect can be observed ay second week of treatment and is dose-dependent. Besides, additional administration of metoprolol 50 mg per day was not associated with further blood pressure decrease but resulted in significant heart rate reduction.

This article examines evidence-based findings in the literature on the efficacy of perindopril 2 mg/indapamide 0.625 mg, a first-line, low-dose antihypertensive drug combination. In regulatory Phase II and III trials, perindopril/indapamide significantly lowered blood pressure compared with other first-line therapies (atenolol, losartan and irbesartan). This was also the case in STRAtegies of Treatment in Hypertension: Evaluation, a postregistration study versus current monotherapies and stepped-care therapy with different classes of antihypertensive agents. The efficacy/safety ratio (both clinical and with regard to laboratory parameters) of perindopril/indapamide was good. Perindopril/indapamide provides additional antihypertensive efficacy compared with each component used alone and with current monotherapies, with major efficacy on systolic blood pressure, an important predictor of cardiovascular risk. It also reduces pulse pressure, an independent cardiovascular risk factor, large-vessel arterial stiffness and microcirculatory alterations. The fixed dosage of a once-daily tablet, ensures optimal ease of use and enhances patient compliance. Perindopril/indapamide also reduces target organ damage in patients at high cardiovascular risk, such as patients with cardiac hypertrophy and Type 2 diabetics with albuminuria. These benefits, together with the good efficacy/tolerability ratio, fulfill the requirements of the European Society of Hypertension and of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines for low-dose, first-line combination therapy in hypertension.

Tubulointerstitial injury is both a key feature of diabetic nephropathy and an important predictor of renal dysfunction. N-Acetyl B glucosaminidase (NAG) is derived from proximal tubular cells and is widely used to evaluate tubular renal function.The objective of this study is whether NAG can be used as an early marker of diabetic nephropathy by comparing the urinary NAG levels between healthy controls and diabetic patients and determining changes in urinary NAG excretion after treatment with low-dose combination perindopril (2 mg)/ indapamide (0.625 mg)/o.d.A total of 50 patients (29 female) with type II diabetes mellitus applying to our diabetes outpatient clinics for the first time were included in our study (Group 1). Diabetic patients were classified into three subgroups on the basis of their duration of diabetes: Group 1A (n = 15)or = 3 years, Group 1B (n = 19) 3 to 5 years, and Group 1c (n = 16)5 years. The inclusion criteria were no prior use of antihypertensive agents; blood pressure130/85 mmHg; urinary albumin excretion30 mg/day; and absence of renal failure, diabetietes, and hypertensive retinopathy. A total of 30 healthy individuals (16 female) (Group 2) were assessed as the control group. Systolic and diastolic blood pressures, HbA1c, body mass index, 24-h microalbuminuria (MAU), and NAG measurements in urine samples were performed by using colorimetric assay method in an analyzer (Roche Cobas Mira). The assay defined as fragmentation of 3-cresolsulfonphthaleinyl-N-acetyl-beta-D-glucosaminide molecule by NAG to 3-cresolsulphonphthalein and N-acetylglucosamine molecules and serum creatinine were measured in all groups. Type II diabetic patients were administered perindopril (2 mg)/indapamide (0.625 mg) combination once daily for 4 months, and urinary NAG levels were measured at the end of treatment.Statistically significant differences were observed between the groups 1 and 2 with respect to the levels of NAG and HbA1c (p0.05). In the treatment group, NAG levels decreased significantly (p0.05), whereas blood pressure and HbA1c levels did not change significantly (p0.05). In diabetic patients, pretreatment NAG were lowest in Group 1A and highest in Group 1c, although the difference between the treatment subgroups was not statistically significant (p0.05).Urinary NAG excretion is elevated in type II diabetic patients as compared with the healthy individuals. Perindopril/indapamide administration is effective in reducing urinary NAG excretion in these patients, and this effect seems to be independent from blood pressure and glycemia control. Presence of tubular proteinuria may be an early indicator of diabetic renal disease in patients without microalbuminuria. Perindopril (2 mg)/ indapamide (0.625 mg)/o.d. treatment may have beneficial effect on the tubulointerstitial damage in diabetic kidney disease.

The association of low doses of perindopril and indapamide in a single pill has been developed to meet the criteria required for a fixed-dose combination to be used as first-line therapy. The experience accumulated so far has demonstrated a greater antihypertensive efficacy of this preparation compared with various monotherapies, but not at the expense of a worsening of tolerability. The perindopril/indapamide combination is particularly effective in lowering systolic and pulse blood pressure. Starting treatment with this fixed-dose combination improves arterial stiffness and allows a better regression of cardiac hypertrophy than angiotensin-converting enzyme-inhibition or beta-adrenoceptor blockade alone. In hypertensive patients with Type 2 diabetes, a greater reduction of urinary albumin excretion can be obtained with the perindopril/indapamide association compared with an angiotensin-converting enzyme inhibitor administered as monotherapy. There is evidence that a first-line management of hypertension based on a low-dose perindopril/indapamide combination can provide a better efficacy/safety ratio than other well-established therapeutic strategies.

Meta-analyses of clinical trials of antihypertensive medications which have measured regression of left ventricular hypertrophy reveal differences between classes of agent, with ACE inhibitors, angiotensin receptor blockers (ARBs), and calcium antagonists being more effective than beta-blockers. The PICXEL study showed that a strategy based on a low-dose combination of the ACE inhibitor perindopril and the diuretic indapamide was significantly more effective than the ACE inhibitor enalapril alone in reducing left ventricular mass. The cardioprotective effect of the combination appears to be independent of its blood pressure lowering effect. A pilot study in patients has shown that perindopril/indapamide improves coronary perfusion which is reduced in hypertension, especially in patients with left ventricular hypertrophy. In a separate study perindopril/indapamide has shown a trend towards reducing cardiovascular events. Animal studies suggest that the combination reverses the changes in arteriolar and capillary densities associated with hypertension. Clinical and experimental studies of the cardioprotective actions of antihypertensive agents are providing a better understanding of how cardiovascular complications in hypertension can be reduced by careful choice of antihypertensive medication.

Aim: The aim of this study was to provide a pharmacoeconomic profile of Preterax® (perindopril/indapamide) [Servier, France] based on the application of validated analytical methodologies to recently published clinical trial results. Method: Pharmacoeconomic models were applied to studies comparing perindopril/indapamide with losartan and irbesartan in essential hypertension, and with enalapril in hypertensive diabetic patients with albuminuria. The daily cost savings per 1mm Hg reduction in blood pressure (BP) associated with reduced need for dialysis were calculated. The analyses were adapted for Germany, France and Italy, based on drug acquisition costs in euro at December 2002. The costs of end-stage renal disease were calculated at October 2002 prices in euro, based on January 1991 prices in deutschmark adjusted for inflation and exchange rate. Results: The cost of BP normalisation with perindopril/indapamide was compared with losartan and irbesartan in two studies. The cost of BP normalisation with perindopril/indapamide was 27.83% less than that with losartan in Germany, 14.97% less in France and 30.36% less in Italy. The cost of BP normalisation with perindopril/indapamide was 41.40% less than that with irbesartan in Germany, 53.73% less in France and 30.36% less in Italy. Discussion: Perindopril/indapamide costs less per patient per year than losartan and irbesartan to normalise BP, increase life expectancy, and prevent cardiovascular and cerebrovascular disease. In comparison with enalapril, perindopril/indapamide ensured greater overall treatment savings despite a drug acquisition cost in favour of enalapril. Conclusion: Perindopril/indapamide should be considered for first-line treatment of essential hypertension and of albuminuria in patients with type 2 diabetes mellitus.

ResumeL’hypertension arterielle contribue a alterer la fonction renale en accelerant les remaniements structurels au niveau des reins, ce qui entraine une diminution progressive de la filtration glomerulaire. L’hypertension arterielle et les anomalies microcirculatoires peuvent creer un cercle vicieux, dans lequel les lesions renales contribuent a majorer le niveau de pression arterielle. La prevention de l’alteration de la fonction renale est une priorite, en particulier dans la population de plus en plus nombreuse des patients hypertendus diabetiques. Il est etabli que les inhibiteurs de l’enzyme de conversion (IEC) et les antagonistes des recepteurs a l’angiotensine II (AAII) exercent des effets nephroprotecteurs; de plus, les IEC diminuent le risque de survenue d’une microalbuminurie, laquelle constitue le stade inaugural de l’insuffisance renale chez le diabetique. Des resultats trEs interessants ont ete obtenus avec une pluritherapie fixe faiblement dosee associant un IEC, le perindopril, et un diur...