Effects of perindopril/indapamide fixed high dose combination on ambulatory blood pressure in subjects with previously uncontrolled arterial hypertension

Objective. To improve blood pressure (BP) control in subjects with uncontrolled arterial hypertension treated by monotherapy with high doses of ACE inhibitors (ACEi) or angiotensin II receptor antagonists (ARA) or with the combination of ACEi or ARA with another antihypertensive agent in moderate doses. Design and methods. Forty six non-diabetic hypertensive subjects with clinic BP > 150/90 mmHg on monotherapy and > 140/90 mmHg on combination therapy with daytime ambulatory BP > 135/85 mmHg were switched to fixed-dose combination of perindopril A 10 mg/indapamide 2,5 mg for 12 weeks. Clinic and ambulatory BP measurements and laboratory evaluations were performed. Results. At baseline 39 % subjects received combination therapy, clinic BP was 162,6 ± 4,2/98 ± 3,0 mmHg, 24-h BP 146,1 ± 8,2/88,3 ± 6,0, daytime BP 147,8 ± 8,8/90,2 ± 4,2 mmHg, night-time BP 131,7 ± 5,5/81,6 ± 4,8. After 12 weeks clinic BP was 131,5 ± 4,2/82,4 ± 5,4 mmHg, target BP < 140/90 mmHg was achieved in 89 %, masked uncontrolled hypertension (clinic BP < 140/90 mmHg and daytime ambulatory BP > 135/85 mmHg) was found in 7 %. Treatment with perindopril A 10 mg/indapamide 2,5 mg was associated with significant decrease in 24-h, day- and night-time ambulatory BP, daytime systolic BP variability and morning surge, improvement of night-peaker diurnal BP pattern. No hypotensive episodes with daytime BP < 90/60 mmHg, or night-time BP < 80/50 mmHg, neither significant changes in glomerular filtration rate, hypokaliemia (< 3,5 mmol/l or < 3,2 mmol/l) or hyperkaliemia >5,1 mmol/l were observed. Conclusion. In uncontrolled arterial hypertension change from monotherapy with nearly to high doses of ACEi or ARA or from combination of ACEI or ARA with another antihypertensive agent to fixed dose combination of perindopril A 10 mg/indapamide 2,5 mg results in a well-tolerated significant reduction in clinic and ambulatory BP with low rate of masked uncontrolled hypertension.

arterial hypertension, combination therapy, ambulatory blood pressure monitoring, masked uncontrolled hypertension

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