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Efficacy and Tolerability of Fixed-Dose Combination Perindopril/Indapamide in Hypertensive Patients with a History of Stroke or Transient Ischemic Attack: PICASSO Trial

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Abstract

Introduction

In everyday medical practice, physicians often need to manage patients whose blood pressure is not well controlled. Those with a history of cerebrovascular disease are a high-risk group in need of rapid blood pressure control.

Methods

The PICASSO study was a real-life, observational trial involving 9257 inadequately treated hypertensive patients who were switched from previous therapy to the fixed-dose combination of perindopril 10 mg/indapamide 2.5 mg (PI) for 3 months. A subanalysis of data of 1117 hypertensive patients who met the clinical criteria of previous stroke or transient ischemic attack was performed. Twenty-four hour ambulatory blood pressure measurements (ABPMs) were also done in a small group of patients (n:38).

Results

At baseline, mean systolic/diastolic blood pressure (SBP/DBP) was 161.5 ± 15.2/93.1 ± 9.9 mmHg. After 1 month with the fixed dose of PI, average office SBP/DBP decreased to 140.0 ± 11.9/83.5 ± 7.7 mmHg. After 3 months, SBP/DBP had dropped to 132.9 ± 9.8/80.0 ± 6.2 mmHg, by 28.6 ± 15.5/13.1 ± 10.0 mmHg (p < 0.001). Blood pressure control rate (< 140/90 mmHg) was 67.3% after 3 months. When data were stratified by baseline blood pressure, decreases in SBP/DBP were statistically significant in patients with all grades (1–3) of hypertension. In patients previously treated with an angiotensin-converting enzyme inhibitor ± hydrochlorothiazide (n = 677), blood pressure decreased by 29.8 ± 15.5/13.3 ± 10.2 mmHg (p < 0.001). Decreases in 24-h ABPM values were also significant (n = 38). Treatment was well tolerated; only a few adverse events were recorded.

Conclusion

This study suggests that fixed combination perindopril 10 mg/indapamide 2.5 mg is an effective and well-tolerated treatment for patients with a history of stroke or transient ischemic attack.

Funding

EGIS Pharmaceuticals Plc.

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References

  1. Zhang H, Thijs L, Staessen JA. Blood pressure lowering for primary and secondary prevention of stroke. Hypertension. 2006;48:187–95.

    Article  PubMed  CAS  Google Scholar 

  2. World Health Organisation. Global health risks: mortality and burden of disease attributable to selected major risks. Geneva: Switzerland WHO Press; World Health Organization; 2009.

    Google Scholar 

  3. Ohkubo T, Asayama K, Kikuya M, et al. Prediction of ischaemic and haemorrhagic stroke by self-measured blood pressure at home: the Ohasama study. Blood Press Monit. 2004;9(6):315–20.

    Article  PubMed  Google Scholar 

  4. Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13.

    Article  PubMed  Google Scholar 

  5. Peters R, Beckett N, McCormack T, et al. Treating hypertension in the very elderly-benefits, risks, and future directions, a focus on the hypertension in the very elderly trial. Eur Heart J. 2014;35:1712–8.

    Article  PubMed  Google Scholar 

  6. Dhamoon MS, Sciacca RR, Rundek T, et al. Recurrent stroke and cardiac risks after first ischemic stroke: the Northern Manhattan Study. Neurology. 2006;66:641–6.

    Article  PubMed  CAS  Google Scholar 

  7. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31:1281–357.

    Article  PubMed  CAS  Google Scholar 

  8. Mourad JJ, Waeber B, Zannad F, et al. Comparison of different therapeutic strategies in hypertension: a low-dose combination of perindopril/indapamide versus a sequential monotherapy or a stepped-care approach. J Hypertens. 2004;22:2379–86.

    Article  PubMed  CAS  Google Scholar 

  9. Mallion JM, Chamontin B, Asmar R, et al. Twenty-four-hour ambulatory blood pressure monitoring efficacy of perindopril/indapamide first-line combination in hypertensive patients: the REASON study. Am J Hypertens. 2004;17:245–51.

    Article  PubMed  CAS  Google Scholar 

  10. PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001;358(9287):1033–41.

    Article  Google Scholar 

  11. Mogensen CE, Viberti G, Halimi S, et al. Effect of low-dose perindopril/indapamide on albuminuria in diabetes: preterax in albuminuria regression: PREMIER. Hypertension. 2003;41:1063–71.

    Article  PubMed  CAS  Google Scholar 

  12. Dahlöf B, Gosse P, Gueret P, et al. Perindopril/indapamide combination more effective than enalapril in reducing blood pressure and left ventricular mass: the PICXEL study. J Hypertens. 2005;23:2063–70.

    Article  PubMed  Google Scholar 

  13. Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358:1887–98.

    Article  PubMed  CAS  Google Scholar 

  14. Farsang C, Picasso Investigators. Blood pressure and metabolic efficacy of fixed-dose combination of perindopril and indapamide in everyday practice. Blood Press. 2013;22(Suppl 1):3–10.

    Article  PubMed  CAS  Google Scholar 

  15. Farsang C. Efficacy and tolerability of fixed-dose combination of perindopril/indapamide in type 2 diabetes mellitus: PICASSO trial. Adv Ther. 2014;31(3):333–44.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Coverex-AS Komb Forte. Summary of product characteristics. Budapest: EGIS Pharmaceuticals Plc; 2009.

    Google Scholar 

  17. PATS Collaborating Group. Post-stroke antihypertensive treatment study. A preliminary result. Chin Med J (Engl). 1995;108(9):710–7.

    Google Scholar 

  18. Arima H, Chalmers J, Woodward M, et al. Lower target blood pressures are safe and effective for the prevention of recurrent stroke: the PROGRESS trial. J Hypertens. 2006;24:1201–8.

    Article  PubMed  CAS  Google Scholar 

  19. Walters M, Muir S, Shah I, et al. Effect of perindopril on cerebral vasomotor reactivity in patients with lacunar infarction. Stroke. 2004;35:1899–902.

    Article  PubMed  CAS  Google Scholar 

  20. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:2160–236.

    Article  PubMed  Google Scholar 

  21. Liu Lisheng, et al. Blood pressure reduction for the secondary prevention of stroke: a Chinese trial and a systematic review of the literature. Hypertens Res. 2009;32:1032–40.

    Article  PubMed  Google Scholar 

  22. National Clinical Guideline Centre (UK). Hypertension: Clinical management of primary hypertension in adults (NICE clinical guideline 127). London. 2011.

  23. Kuo SW, Pei D, Hung YJ, et al. Effect of indapamide SR in the treatment of hypertensive patients with type 2 diabetes. Am J Hypertens. 2003;16:623–8.

    Article  PubMed  CAS  Google Scholar 

  24. Hróbjartsson A, Gøtzsche PC. Placebo interventions for all clinical conditions. Cochrane Database Syst Rev. 2004;3:CD003974 (Review. Update in: Cochrane Database Syst Rev. 2010;(1):CD003974).

    Google Scholar 

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Acknowledgements

The authors acknowledge the contribution of all members of the PICASSO investigator group and would like to acknowledge the assistance of Bela Malomvölgyi, MD (medical advisor), and Norbert Habony, MD (coordinator).

Funding

PICASSO study was funded by EGIS Pharmaceuticals Plc. (Budapest, Hungary). The article processing charges were funded by Szívkatéterezés Győr Alapítvány. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. The authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Disclosures

Csaba András Dézsi and Csaba Farsang have nothing to disclose.

Compliance with Ethics Guidelines

All patients signed informed consent prior to enrollment in the study. The Ethics Committee of the Hungarian Medical Research Council (TUKEB no. 8-34812009-1018EKU (866/PII09.) approved the protocol. This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors.

Data Availability

The data sets during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Petz Aladár County Teaching Hospital, Győr, Hungary

    Csaba András Dézsi

  2. Hospital Outpatient Care for Hypertensive Patients, St. Imre University Teaching Hospital, Budapest, Hungary

    Csaba Farsang

Authors
  1. Csaba András Dézsi
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  2. Csaba Farsang
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on behalf of The PICASSO Investigators

Corresponding author

Correspondence to Csaba András Dézsi.

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Dézsi, C.A., Farsang, C. & on behalf of The PICASSO Investigators. Efficacy and Tolerability of Fixed-Dose Combination Perindopril/Indapamide in Hypertensive Patients with a History of Stroke or Transient Ischemic Attack: PICASSO Trial. Adv Ther 35, 644–654 (2018). https://doi.org/10.1007/s12325-018-0705-1

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