Comparison of single-pill strategies first line inhypertension: perindopril/amlodipine versusvalsartan/amlodipine

ABSTRACT

An international double-blind, parallel-group,randomized controlled trial was performed to determinethe efficacy and safety of a new first-line strategy in mildto moderate hypertension based on a single-pillcombination of perindopril/amlodipine versus a validatedstepped-care strategy (initiation with valsartanmonotherapy, up-titrating to valsartan/amlodipine after2 months).Methods: At inclusion, patients received perindopril/amlodipine 3.5/2.5mg or valsartan 80 mg. At 1, 2, and3 months, patients were up-titrated if they haduncontrolled hypertension ( 140/90 mmHg). The uptitrationsteps were perindopril/amlodipine 7/5 mg,14/10 mg, and 14/10mg R indapamide sustained release1.5 mg; or valsartan 160 mg, valsartan/amlodipine160/5 mg, and 160/10 mg. The two groups were similarat baseline (55.5 years, 53% men, blood pressure163.5/100.2 mmHg); 881 perindopril/amlodipine and876 valsartan/amlodipine patients were analyzed forefficacy.Results: After 1 month, the rate of controlledhypertension was 33% with perindopril/amlodipine versus27% with valsartan/amlodipine (estimate of difference,R6.1%; P»0.005); this between-strategy differenceremained significant at every visit (P<0.05). After 3months, blood pressure was 137.8 12.4/83.3 8.7 and139.7 13.3/84.8 9.0 mmHg, respectively, with greaterreductions from baseline with perindopril/amlodipine(primary endpoint 2.0/ 1.5 mmHg; both P<0.001).Similar results were observed at all other visits (allP 0.001). The safety of the two strategies wasequivalent.Conclusions: The three-step strategy of initiation withsingle-pill perindopril/amlodipine produces greaterreductions in blood pressure, and better and quicker ratesof control of hypertension. This can be expected to beassociated with benefits beyond blood pressure control,notably improved compliance and better cardioprotection.Keywords amlodipine, hypertension, perindopril, singlepillcombination, valsartan...