indapamide--perindopril-drug-combination and Hypertension--Renal

Several studies have demonstrated that abnormalities in the function and structure of the coronary microcirculation occur in many clinical conditions, including arterial hypertension in which it might contribute to cardiovascular morbidity and mortality. This dysfunction is caused by remodelling of vascular and extravascular structures as well as abnormal coronary haemodynamics. Whether antihypertensive treatment can lead to reverse remodelling of the coronary microvasculature remains to be determined. The preliminary results of a recent study in patients with arterial hypertension and left ventricular hypertrophy show that 6 months' treatment with a combination of perindopril and indapamide is accompanied by a significant decrease in blood pressure and left ventricular mass and an increase in resting and hyperaemic myocardial blood flow measured non-invasively with positron emission tomography. This suggests that coronary microvascular dysfunction can be reversed by treatment with these drugs and might contribute to the prevention of ischaemic heart disease in these patients.

Topics: Antihypertensive Agents; Cardiotonic Agents; Coronary Artery Disease; Drug Combinations; Humans; Hypertension, Renal; Indapamide; Microcirculation; Perindopril

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.. 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.. 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.. 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.

Topics: Aged; Blood Pressure; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Drug Combinations; Female; Follow-Up Studies; Humans; Hypertension, Renal; Indapamide; Male; Middle Aged; Perindopril; Placebos; Treatment Outcome