Abstract :
Because of the importance of attaining rapid and tight blood-pressure (BP) control, those guidelines that base treatment recommendations on a risk-stratification approach include combination therapies as first-line pharmacologic treatment options. Monotherapies were shown to be ineffective in many patients, and delays in BP control significantly increase the risk of cardiac events, stroke, and death. In diabetic patients in whom BP control is particularly hard to achieve, the use of angiotensin-converting enzyme (ACE) inhibitors, which inhibit the renin-angiotensin system, has been recommended. Consistent with these guidelines, comparative clinical trials confirmed the value of the ACE inhibitor-and-diuretic combination treatment, perindopril/indapamide, in hypertensive diabetic patients and in patients with uncomplicated essential hypertension, multiple risk factors, and associated clinical conditions. Perindopril/indapamide was shown to have an early and sustained effect on systolic BP, and a specific and positive effect on hemodynamics. Treatment attenuates carotid-wave reflections and pulse-wave velocity, both of which are components of pulse pressure and are determinants of left-ventricular afterload, myocardial hypertrophy, and myocardial oxygen consumption. In diabetic patients with albuminuria, perindopril/indapamide treatment significantly reduces BP, the albumin excretion rate, and the urinary albumin:creatinine ratio. The nephroprotective effects of perindopril/indapamide remain significant after adjustment for changes in BP. Together, these data suggest that a combination of perindopril and indapamide, through its effect on BP-lowering and target-organ protection, is suited to the medical needs of a wide range of hypertensive patients, including those with diabetes.
