What are the long-term effects of using perindopril (Angiotensin-Converting Enzyme Inhibitor)?

From the Guidelines

Perindopril has been shown to have beneficial long-term effects, including reduced risk of cardiovascular events and protection against kidney damage, as demonstrated in the ADVANCE study 1, which found a 9% reduction in major macrovascular and microvascular events and a 14% reduction in death from any cause. The use of perindopril, an angiotensin-converting enzyme (ACE) inhibitor, has several long-term effects when used for conditions like hypertension and heart failure.

• The beneficial long-term effects include:
  • Reduced risk of cardiovascular events such as heart attacks and strokes
  • Improved survival in heart failure patients
  • Protection against kidney damage (particularly in diabetic patients)
  • Potential reduction in the development of new-onset diabetes However, perindopril also has potential long-term side effects that patients should be aware of, including:
• Persistent dry cough (occurring in 5-20% of patients)
• Reduced kidney function (especially in those with pre-existing kidney disease or renal artery stenosis)
• Hyperkalemia (elevated potassium levels)
• Rarely angioedema Some patients may experience fatigue or dizziness due to blood pressure reduction. ACE inhibitors like perindopril work by blocking the conversion of angiotensin I to angiotensin II, reducing vasoconstriction and decreasing aldosterone production, which helps lower blood pressure and reduces cardiac workload. Regular monitoring of kidney function and potassium levels is important for patients on long-term perindopril therapy, particularly in the elderly or those with existing kidney problems, as supported by the PROGRESS Study 1, which found a 30% reduction in the risk of major cardiovascular events and a 35% reduction in the risk of stroke in patients with chronic kidney disease. The most recent and highest quality study, ADVANCE 1, provides strong evidence for the long-term benefits of perindopril, and its findings should be prioritized in clinical decision-making.

From the FDA Drug Label

The EUROPA study showed that perindopril significantly reduced the relative risk for the primary endpoint events (Table 1). This beneficial effect is largely attributable to a reduction in the risk of non-fatal myocardial infarction. This beneficial effect of perindopril on the primary outcome was evident after about one year of treatment (Figure 1). The mean follow-up was 4.2 years. The study examined the long-term effects of perindopril on time to first event of cardiovascular mortality, nonfatal myocardial infarction, or cardiac arrest in patients with stable coronary artery disease.

The long-term effects of using perindopril include a significant reduction in the risk of non-fatal myocardial infarction and cardiovascular mortality. The beneficial effects of perindopril are evident after about one year of treatment and continue over a mean follow-up period of 4.2 years 2.

• The reduction in risk is largely due to a decrease in non-fatal myocardial infarction.
• Perindopril also reduces the risk of cardiovascular mortality and cardiac arrest, although to a lesser extent.
• The long-term effects of perindopril are similar across all predefined subgroups by age, underlying disease, or concomitant medication.

From the Research

Long-term Effects of Perindopril

The long-term effects of using perindopril, an Angiotensin-Converting Enzyme Inhibitor, have been studied in various research papers.

• Perindopril has been found to be safe and effective for the treatment of hypertension, with a favorable safety profile 3, 4, 5.
• In patients with normal renal function, long-term administration of perindopril (up to 18 months) did not result in significant variations in plasma creatinine levels 3, 6.
• The incidence of cough, a common side effect of ACE inhibitors, was found to be 1.2% to 2.9% in patients treated with perindopril, which is relatively low compared to other ACE inhibitors 3, 7.
• Perindopril has been shown to be well tolerated in a wide range of patients, including the elderly and those with heart failure or renal disease 4, 5.
• The combination of perindopril with a thiazide diuretic has been found to be safe and effective, with no reported harmful drug interactions 3, 4.

Adverse Effects

• The most common adverse effects of perindopril include cough, hypotension, and hyperkalemia, although these effects are relatively rare 3, 5, 7.
• Symptomatic hypotension was rarely reported with perindopril, even in situations of salt and water depletion 3, 6.
• Perindopril has been found to have no negative effects on lipids or glycemic control, and it reduces proteinuria in patients with renal disease 5.

Efficacy

• Perindopril has been shown to be effective in reducing blood pressure in patients with mild to moderate essential hypertension, with response rates of 67% to 80% 4, 7.
• Perindopril has also been found to be effective in patients with severe hypertension or congestive heart failure, although further research is needed to confirm these findings 4, 7.