New drug combination could be treatment of choice for reducing high blood pressure

This study investigated whether giving a combination of perindopril (at 3.5 mg) with amlodipine (2.5 mg) is effective in treating high blood pressure.

Hypertension (high blood pressure) refers to when pressure inside blood vessels is too high. This causes the heart to have to work harder in order to pump blood against the extra pressure. Over time, the heart becomes stiff and loses it's ability to pump blood efficiently and can result in blood clots forming. Uncontrolled hypertension increases the risk of cardiovascular events, such as a heart attack, stroke and heart failure.

When blood pressure is measured two numbers are shown: the top number measures the pressure in the arteries when the heart is beating (called systolic blood pressure: SBP), and the bottom number measures pressure when the heart is relaxed or filling (called diastolic blood pressure: DBP). Blood pressure is considered normal at around 120/80 mmHg.

Treatment for hypertension includes antihypertensive drugs. Most often, a combination of at least two different antihypertensive drugs is needed to successfully lower blood pressure. Antihypertensive drugs include angiotensin converting enzyme (ACE) inhibitors such as perindopril (Aceon) and calcium channel blockers such as amlodipine (Norvasc). A challenge in successfully treating hypertension is finding the right drug combination and dose.

This study investigated whether using a fixed dose of perindopril (3.5 mg) and amlodipine (2.5 mg) daily is effective in reducing hypertension in patients that are receiving antihypertensive treatment for the first time (first-step treatment).

A total of 1,581 patients (average age 52 years) with mild-to-moderate hypertension were randomly assigned to one of 6 groups.

• Group 1: 3.5 mg perindopril and 2.5 mg amlodipine per day
• Group 2: 3.5 mg perindopril per day
• Group 3: 2.5 mg amlodipine per day
• Group 4: 5 mg perindopril per day
• Group 5: 5 mg amlodipine per day
• Group 6: placebo (substance with no effect used as a comparison)

The study found that the combination of perindopril/amlodipine was successful in reducing blood pressure, compared to placebo. SBP was reduced on average by 7.22 mmHg and DBP was reduced on average by 4.12 mmHg. The effects of perindopril/amlodipine were evident at 2 weeks. Similarly, the combination of drugs was superior in reducing blood pressure compared to perindopril 3.5 mg alone or amlodipine 2.5 mg alone, and was not inferior to perindopril 5 mg and amlodipine 5 mg. 

A common side effect of amlodipine is swelling of the legs, and this study noted that leg swelling was less frequent with the combination of perindopril (3.5 mg) and amlodipine (2.5 mg) than with amlodipine (5 mg) as a treatment on its own.

The study concluded that combination therapy with perindopril (3.5 mg) and amlodipine (2.5 mg) is effective and fast at lowering blood pressure and has a favorable side effect profile.  

This study had a relatively short treatment period of 8 weeks and excluded patients with obesity, kidney problems, diabetes, and cardiovascular disease. 

If you or someone you know have recently been diagnosed with hypertension, talk to a doctor about combination therapy such as perindopril (3.5 mg) and amlodipine (2.5 mg).