Perindopril arginine + amlodipine for the treatment of hypertension in the USA

Abstract

Introduction: Controlling blood pressure is a global health priority; single-pill combinations of antihypertensive agents are often prescribed to improve adherence, persistence, and outcomes.

Areas covered: A novel preparation of perindopril arginine and amlodipine besylate was approved by the US Food and Drug Administration on 21 Jan 2015, based primarily on a 837-subject, 6-week, randomized, multicenter, prospective, clinical trial. The maximal marketed dose of the combination (14/10 mg daily) lowered both systolic and diastolic blood pressure significantly more than either monotherapy, with a reduction in adverse effects (especially ankle edema), compared to amlodipine alone.

Expert opinion: Substantial clinical trial experience with amlodipine or perindopril suggests that these two agents effectively lower blood pressure, and may reduce the risk of major adverse cardiovascular events. In the Anglo-Scandinavian Cardiac Outcomes Trial, hypertensive subjects randomized to receive these two drugs (in sequence) had a significantly lower incidence of several types of clinical events, compared to those who received atenolol ± bendroflumethiazide. The new formulation of perindopril arginine protects its ethyl ester, without requiring physical separation from amlodipine in a single pill, and is less hydroscopic than perindopril erbumine. These and other attributes may make this combination an attractive addition to the antihypertensive armamentarium.

Keywords:

• angiotensin converting-enzyme inhibitor
• calcium antagonist
• clinical trials

Declaration of interests

WJ Elliott has received royalties from Elsevier and UpToDate® for his work as an author and/or editor. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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