Blood pressure (BP) control remains challenging, with most patients requiring a combination of two antihypertensive drug classes to reach BP targets. Angiotensin-converting enzyme (ACE) inhibitors and β-blockers are two recommended classes. This subanalysis of OPTITEN assessed the antihypertensive efficacy of perindopril in patients receiving bisoprolol at baseline.Design and method:
OPTITEN was a prospective, multicenter, open-label study in 990 Serbian patients with grade 1 and grade 2 hypertension. At baseline, 23% (n = 224) received bisoprolol. In this subgroup, 7.1% had a history of coronary artery disease, 6.7% of myocardial infarction, 38.8% of diabetes, and 4.5% of renal disease. BP readings were performed at baseline and during follow-up at weeks 2, 6, and 10. Patients were started on perindopril 5 mg (62%) or 10 mg (38%) at the physician's discretion at baseline. At week 2, patients were uptitrated from 5 mg to 10 mg perindopril if BP remained uncontrolled (superior or equal to 140/90 mmHg). Patients initiated on perindopril 10 mg had a significantly higher cardiovascular risk profile and BP level at baseline.Results:
In patients receiving bisoprolol at baseline, the addition of perindopril significantly decreased systolic BP (SBP) by 24.6 mmHg (156.6 ± 13.3 to 132 ± 11.1 mmHg; P < 0.0001) and diastolic BP (DBP) by 12.1 mmHg (92.3 ± 8.5 to 80.2 ± 5 mmHg; P < 0.0001) at week 10. BP control rate (inferior or equal to 140/90 mmHg) was 86.5% (n = 192) at week 10. Furthermore, there were significantly greater BP reductions in patients initiated on perindopril 10 mg vs 5 mg seen as early as week 2 (SBP: −18.4 mmHg vs −13.3 mmHg respectively, P = 0.0045; DBP: −9.6 mmHg vs −6.7 mmHg respectively, P = 0.0068) which were maintained at week 10 (SBP: −27.6 mmHg vs −22.8 mmHg respectively, P = 0.0194; DBP: −13.8 mmHg vs −11 mmHg respectively, P = 0.0208). Despite different risk profiles, patients initiated on perindopril 5 mg and 10 mg achieved similar BP control rates (P = 0.0683).Conclusions:
This analysis confirms that in patients with uncontrolled BP on bisoprolol, the addition of perindopril significantly decreases BP, allowing a control rate of 86.5%. Despite higher cardiovascular risk in patients initiated on perindopril 10 mg, there was a greater reduction in BP vs those initiated on perindopril 5 mg, allowing similar control rates at week 10 in both arms.