Ambulatory blood pressure in hypertensive patients with left ventricular hypertrophy: efficacy of first-line combination perindopril/indapamide therapy

Abstract

Background: Ambulatory blood pressure (BP) is more sensitive than office BP and is highly correlated with the left ventricular mass (LVM) of hypertensive patients with left ventricular hypertrophy (LVH).

Methods: In this prospectively designed ancillary study of the PICXEL trial, the effects of first-line combination perindopril/indapamide on ambulatory BP were compared with those of monotherapy with enalapril in 127 patients. Hypertensive patients with LVH received once daily either perindopril 2 mg/indapamide 0.625 mg (n = 65) or enalapril 10 mg (n = 62) for 52 weeks. Dose adjustments were allowed for uncontrolled BP. Twenty-four-hour ambulatory BP and echocardiographic parameters were measured at baseline, week 24, and week 52.

Results: At study end, both treatments significantly improved ambulatory BP compared with baseline (p < or = 0.01). Perindopril/indapamide treatment reduced 24-hour and daytime systolic BP (SBP) and pulse pressure (PP) significantly more than enalapril treatment (p < 0.01). No significant between-group differences were noted for diastolic BP (DBP) or for night-time measurements. Trough/peak ratios were higher with perindopril/indapamide than with enalapril (88.5 vs 65.8 for SBP and 86.7 vs 63.9 for DBP, respectively). The global smoothness index was higher with perindopril/indapamide than with enalapril (6.6 vs 5.2 for SBP and 5.6 vs 4.9 for DBP, respectively). With perindopril/indapamide treatment, LVM index was significantly reduced (-9.1 g/m2 from baseline; p vs baseline <0.001). More patients required dose increases with enalapril (87%) than with perindopril/indapamide (71%). No unusual safety elements were noted.

Conclusions: First-line perindopril/indapamide combination decreased ambulatory SBP and PP, and LVM more effectively than enalapril.

Figure 1

Changes in ambulatory blood pressure after 52 weeks of treatment with perindopril/indapamide (n = 65) or enalapril (n = 62). A. Over 24 hours; B. Daytime; C. Night-time. Mean changes from baseline and standard deviations in parentheses are presented. *p vs baseline ≤0.01; **p vs baseline ≤0.001, ^†p vs enalapril <0.01. Abbreviations: BP, blood pressure; DBP, diastolic blood pressure; PP, pulse pressure; SBP, systolic blood pressure.

Figure 2

Variations in blood pressure over 24 hours in perindopril/indapamide (n = 65) and enalapril (n = 62). A. SBP; B. DBP; C. PP. Mean baseline and end-of-study ambulatory blood pressure calculated every 2 hours are plotted. Abbreviations: DBP, diastolic blood pressure; PP, pulse pressure; SBP, systolic blood pressure.

Figure 3

Relationship between mean systolic blood pressure over 24 hours (mmHg) change (Wend − W0) and left ventricular mass index change in enalapril group (n = 62). ρ: Pearson correlation coefficient.

Figure 4

Relationship between mean SBP over 24 hours (mmHg) change (Wend − W0) and left ventricular mass index change (Wend − baseline) in perindopril/indapamide group (n = 65). ρ: Pearson correlation coefficient. Regression equation: LVMI change (WEND-Baseline) (ENA) = 6.8649 + 0.551855 *SBPMEAN24_CHANGE AT WEND