Antihypertensive efficacy of the ACE-inhibitor perindopril in the elderly

Abstract

To assess the antihypertensive efficacy of the angiotensin-converting enzyme (ACE)-inhibitor, perindopril, in the elderly, patients >65 years of age with supine diastolic blood pressure (BP) ⩾90 and ⩽110 mm Hg at the end of a 4-week placebo washout period were treated with perindopril 4–8 mg/daily vs placebo using a multicentre, randomised, double-blind, parallel group design. Of the 191 patients entered, 183 completed 8 weeks of double-blind therapy. Average age was 72–73 years. Supine and standing BP at the end of the placebo run-in period were 173/96 vs 168/96 mm Hg. BPs were measured in the morning, 20–25 h after the previous day’s dose (ie, at the end of the dosing interval). In the placebo group, supine and standing diastolic BP decreased by 3–4 mm Hg, and systolic BP by 6–7 mm Hg. In the perindopril-group, diastolic BP decreased by 6–7 mm Hg and systolic BP by 10–13 mm Hg (both P < 0.01 vs placebo). These data indicate a substantial placebo response of particularly systolic BP in older hypertensives and indicate the importance of a parallel placebo-group to assess the extent of the actual drug’s effect. Perindopril caused additional decreases in diastolic BP by about 2 mm Hg, and in systolic BP by 4–5 mm Hg. The extent of this drug-effect may be less in older vsmiddle-aged hypertensives.