From the Research
Perindopril is an ACE inhibitor, not an ARB, so there is no direct "equivalent" ARB to perindopril, but if a switch is needed, options like losartan 50-100 mg daily, valsartan 80-160 mg daily, or candesartan 8-32 mg daily can be considered, as they provide similar blood pressure lowering effects to perindopril 4-8 mg daily, as supported by studies such as 1 and 2.
Key Points to Consider
- The main reason for switching from an ACE inhibitor like perindopril to an ARB is typically due to ACE inhibitor-induced cough, which occurs in about 10-20% of patients, as discussed in 3.
- ARBs work by blocking angiotensin II receptors directly rather than inhibiting the conversion of angiotensin I to angiotensin II, which is why they don't cause the cough associated with ACE inhibitors.
- Both medication classes are effective for hypertension, heart failure, and kidney protection in diabetes, though their specific benefits may differ slightly in certain patient populations, as noted in 4 and 5.
- When switching, it's essential to monitor blood pressure closely as individual responses vary, and consider the properties of different ARBs, such as their antihypertensive efficacy and pleiotropic end-organ-protective effects, as highlighted in 2.
Factors Influencing the Choice of ARB
- The choice of ARB should be based on the specific requirements of the individual patient, including their cardiovascular risk profile and the presence of any comorbidities, as emphasized in 1.
- The efficacy and tolerability of different ARBs may vary, and some may be more suitable for certain patient populations, such as those with heart failure or diabetes, as discussed in 4 and 5.
- The use of fixed-dose combinations with hydrochlorothiazide (HCTZ) can increase the antihypertensive effect of ARBs, as mentioned in 2.