The effectiveness of the replacement of the generic blockers of the renin-angiotensin-aldosterone system by perindopril arginine in patients with uncontrolled blood pressure: the results of the regional program “DIFFERENCE”

Taking into account the widespread use of generic drugs and insufficient rate of achieving the target blood pressure (BP), a regional program “DIFFERENCE” was initiated. The purpose of this study was to assess the chance of increasing the effectiveness of antihypertensive therapy (AHT) by replacing generic perindopril and receptor blockers to angiotensin II (BRA) by the original perindopril and generic indapamide by the original one.

Design and methods. The study included 330 hypertensive patients (47,3% males; the average age of men is 53,5 ± 8,5 years, women — 54,2 ± 10,2 years, p > 0,05). The mean systolic BP was 149,5 ± 5,3 mm Hg, average diastolic BP — 96,4 ± 4,9 mm Hg; 1st HTN degree was achieved in 49,1% patients, 2nd — in 41,2%; 3rd degree remained in 9,7%. Monotherapy of HTN was prescribed in 79,4% patients.

Results. After the transfer from the generic perindopril to the original drug (± transfer from the generic indapamide to the original one) within 4 weeks no other changes of AHT were introduced. During these 4 weeks, the average systolic BP decreased to 139,1 ± 5,1 mm Hg, diastolic blood pressure declined to 88,2 ± 5,8 mm Hg, which allowed to achieve the target BP in 37,0% patients (p < 0,01). On the Month 1 visit, taking into account indications, the frequency of combined AHT increased to 76,4%, on the Month 3 visit — to 88,2%, exceeding the original one by 4,3 times (p < 0,01). On the Month 3 visit the average systolic BP was 136,5 mm Hg, diastolic BP — 85,9 mm Hg, the target BP level was achieved in 53,9% cases (p < 0,01). By the study completion, the most often combination included perindopril with diuretic or calcium antagonist.

Conclusions. The study “DIFFERENCE” demonstrated the effectiveness of the replacement of generic perindopril and BRA by the original perindopril combined, if necessary, with the replacement of generic indapamide by the original one in patients wth uncontrolled HTN. To date, the combined AHT has not been assigned frequently enough, which is also the reason for the insufficient efficiency. The most common were the combinations of perindopril with diuretic or calcium antagonist. 

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