Document Detail

Angiotensin-converting enzyme inhibition by perindopril in the treatment of cardiovascular disease.
MedLine Citation:
PMID:  19379059     Owner:  NLM     Status:  MEDLINE    
The angiotensin-converting enzyme (ACE) inhibitor perindopril (Coversyl) is a long-acting lipophilic drug with a high-tissue affinity for the ACE. ACE inhibition by perindopril has two main effects: it inhibits the angiotensin II formation and potentiates bradykinin. Perindopril is one of the ACE inhibitors that has been extensively studied in randomized clinical trials within various patient populations. The clinical efficacy has been demonstrated in patients with hypertension, diabetes mellitus, cerebrovascular disease, stable coronary artery disease (CAD) and heart failure. Perindopril has a positive safety and tolerability profile. Therefore, perindopril, as an ACE inhibitor, has an established place in the major clinical treatment guidelines. This article discusses several studies that have shown that an antihypertensive treatment with perindopril reduces and prevents cardiovascular events in a large range of patients with established vascular disease. The observed cardioprotective benefits of perindopril were independent of blood pressure. The outcome of these and other trials support the concept of specific cardioprotective properties of ACE inhibition by perindopril in addition to the blood pressure-lowering effects, such as anti-atherosclerotic, anti-inflammatory and antithrombotic properties. In addition, the observed consistency of the treatment benefit across subgroups indicates that the absolute benefits conferred by treatment are mainly established by each patient's future risk of vascular complications, rather than their initial blood pressure level or other risk factors. This article describes these issues according to the main studies with perindopril or perindopril-based regimens, concluding that the blood pressure-dependent and -independent cardioprotective effects extend to all patients with vascular disease. This concept supports the provision of ACE inhibitor-based treatment, not on the basis of arbitrary cut-off points for blood pressure but rather on assessment of vascular risk, which is raised in patients with stable CAD, diabetes and stroke.
Jasper J Brugts; Roberto Ferrari; Maarten L Simoons
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Expert review of cardiovascular therapy     Volume:  7     ISSN:  1744-8344     ISO Abbreviation:  Expert Rev Cardiovasc Ther     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-21     Completed Date:  2009-07-15     Revised Date:  2009-08-14    
Medline Journal Info:
Nlm Unique ID:  101182328     Medline TA:  Expert Rev Cardiovasc Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  345-60     Citation Subset:  IM    
Department of Cardiology, Erasmus Medical Centers, Gravendijkwal 230, 3015CE Rotterdam, The Netherlands.
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MeSH Terms
Angiotensin-Converting Enzyme Inhibitors / administration & dosage*,  adverse effects,  pharmacokinetics
Antihypertensive Agents / administration & dosage*,  adverse effects,  pharmacokinetics
Blood Pressure / drug effects
Cardiovascular Diseases / physiopathology,  prevention & control*
Hypertension / complications,  drug therapy,  physiopathology
Perindopril / administration & dosage*,  adverse effects,  pharmacokinetics
Randomized Controlled Trials as Topic
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 82834-16-0/Perindopril
Erratum In:
Expert Rev Cardiovasc Ther. 2009 Jun;7(6):722

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