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Review
. 2025 Mar;21(3):155-166.
doi: 10.1080/14796678.2025.2465218. Epub 2025 Feb 12.

The role of single-pill ACE inhibitor/ccb combination for hypertension: an Algerian view via the nominal group technique

Brahim Kichou  1 , Abed Bouraghda  2 , Hadj Mohamed Ali Lahmar  3 , Sofiane Amara  4 , Yazid Aoudia  5 , Yasmina Benchabi  6 , Farid Haddoum  7 , Adjia Kachenoura  8 , Nadia Laredj  9 , Leila Manamani  10 , Mohamed Tahar Chafik Bouafia  2 , Mohamed Chettibi  11
Affiliations
Review

The role of single-pill ACE inhibitor/ccb combination for hypertension: an Algerian view via the nominal group technique

Brahim Kichou et al. Future Cardiol. 2025 Mar.

Abstract

Around one-third of adults in Algeria have hypertension, but > 40% are unaware they have the disease, and of those receiving treatment, only ~ 20-30% have adequate blood pressure (BP) control. Recommended starting treatment is an angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker plus a calcium channel blocker (CCB) or diuretic. A single-pill combination of perindopril/amlodipine (ACEi/CCB) recently became available in Algeria. Twelve Algerian hypertension experts reviewed the clinical evidence regarding this therapeutic combination to determine its potential role for hypertension management in Algeria. The evidence indicated that this combination reduces cardiovascular outcomes and visit-to-visit BP variability, effectively controls 24-hour BP, and is well tolerated. In conclusion, the perindopril/amlodipine SPC provides a valuable new treatment option for hypertension in Algeria.

Keywords: Algeria; North Africa; amlodipine; cardiovascular disease; hypertension; mortality; perindopril.

Plain language summary

Hypertension (high blood pressure [BP]) is a main cause of heart disease, stroke, kidney disease, and dementia, and the World Health Assembly has a target to reduce the number of people with hypertension by 25% by 2030. Around one-third of Algerian adults have hypertension, but a high proportion of Algerian people with hypertension are unaware that they have the disease. Additionally, most patients receiving hypertension treatment do not have their BP controlled adequately. For most patients, international medical guidelines recommend starting BP treatment with two drugs–one that blocks the renin-angiotensin-aldosterone system (RAAS) plus either a calcium channel blocker (CCB) or a diuretic. Guidelines also recommend that patients receive the two drugs in a single pill (called a ‘single-pill combination’ [SPC]) because this is more convenient and patients are more likely to take the treatment. Recently, a new SPC containing the angiotensin-converting enzyme inhibitor perindopril (which targets the RAAS) and the CCB amlodipine has become available in Algeria. A meeting of Algerian hypertension experts was held on 3 September 2022, to discuss the evidence for this drug combination in treating hypertension and to define the potential role of the perindopril/amlodipine SPC in treating patients with hypertension in Algeria. The evidence indicated that this combination is effective in controlling BP throughout the 24-hour period between doses, reduces the risk of stroke and heart attack, and is well tolerated (safe). The experts concluded that the perindopril/amlodipine SPC provides a valuable new treatment option for hypertension in Algeria.

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Conflict of interest statement

All authors received funding for flights, accommodation, venue, and fees and/or honoraria for participating in the expert meeting from Servier. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

The medical writing assistance was funded by Servier.

Figures

Figure 1.
Figure 1.
Guideline-recommended approaches to patients with uncomplicated hypertension [15,16]. *spironolactone preferred in patients with estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2 and chlorthalidone preferred in patients with eGFR <30 mL/min/1.73 m2 (not on dialysis). Alternatives are (1) other mineralocorticoid receptor antagonist (eGFR ≥30 mL/min/1.73 m2) or other thiazide or thiazide-like diuretic (eGFR <30 mL/min/1.73 m2), or (2) β-blocker or α1-blocker (irrespective of eGFR), or (3) a centrally acting agent (irrespective of eGFR); consider renal denervation if eGFR is >40 mL/min/1.73 m2. RAASis are ACEis or angiotensin II receptor blockers. ACEi, angiotensin-converting enzyme inhibitor; CCB, calcium channel blocker; ESC, European society of cardiology; ESH, European society of Hypertension; ISH, international society of Hypertension; RAASi, renin-angiotensin-aldosterone system inhibitor.
Figure 2.
Figure 2.
Factors determining the choice of antihypertensive agent to combine with RAASis in patients with high-risk hypertension [37]. Reprinted from journal of the American society of hypertension, vol 4(5), Kario K, proposal of ras-diuretic vs. ras-calcium antagonist strategies in high-risk hypertension: insight from the 24-hour ambulatory blood pressure profile and central pressure, pages 215–218, copyright (2010), with permission from Elsevier. ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; BP, blood pressure; CCB, calcium channel blocker; CHF, congestive heart failure; CKD, chronic kidney disease; CV, cardiovascular; RAASi, renin-angiotensin-aldosterone system inhibitor.
Figure 3.
Figure 3.
Forest plot showing the effect of perindopril-amlodipine (n = 9639) versus atenolol-bendroflumethiazide (n = 9618) in hypertensive patients with 3 or more cardiovascular risk factors: results of the ASCOT-BPLA study [32]. Reprinted from the lancet, vol 366, dahlöf B, sever PS, Poulter NR, wedel H, beevers DG, Caulfield M, Collins R, Kjeldsen SE, Kristinsson A, McInnes GT, Mehlsen J, Nieminen M, O’Brien E, Ostergren J, ASCOT investigators.
See this image and copyright information in PMC

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