Fixed Dose Combination of Perindopril and Indapamide Improves Peripheral Vascular Function in Essential Hypertensive Patients

BACKGROUND The effect on endothelium-dependent and independent vasodilation of 24-week treatment with a fixed-dose combination of perindopril/indapamide (2/0.625 mg, daily) and atenolol (50 mg, daily), was evaluated in 62 untreated essential hypertensive patients according a double-blind, parallel group, randomized study. METHODS Brachial artery flow-mediated dilation (FMD), response to sublingual glyceril trinitrate (GTN, 25 mu g) and to cold pressor test (CPT) were measured at baseline and after treatments at 12 and 24 weeks, as change in diameter from ultrasound scans by a computerized system RESULTS Blood pressure (BP) was (P < 0.001) reduced in both groups, but to a greater (P < 0.01) extent in the perindopril/indapamide group. After 24 weeks, FMD was significantly increased (P < 0.01) by perindopril/indapamide (from 5.0 +/- 2.1 to 6.0 +/- 1.7%) but not by atenolol (from 5.1 +/- 1.8 to 5.5 +/- 1.8%). Improvement in FMD was not statistically related to BP reduction. Response to GTN was also significantly (P < 0.05) increased by perindopril/indapamide (from 6.2 +/- 1.9 to 6.9 +/- 1.7%), but not by atenolol (from 6.1 +/- 2.8 to 6.6 +/- 2.6%). Improvement in GTN response was significantly (P < 0.05) related to BP reduction. Response to CPT was significantly increased (P < 0.001) by perindopril/indapamide after 12 and 24 weeks, whereas atenolol significantly (P < 0.05) improved it only after 24 weeks. CONCLUSIONS Treatment with perindopril/indapamide improves endothelium-dependent vasodilation in comparison with atenolol. This improvement was observed without significant relations with BP changes, suggesting a pressure-independent effect. Improvement in endothelium-independent and sympathetic-associated vasodilation was also observed. These results suggests that long term therapy with a fixed-dose combination of perindopril/indapamide affords vascular protection in hypertensive patients.