Angiotensin-converting enzyme inhibition by perindopril in cardiovascular disease

Large clinical trials have documented the efficacy of angiotensin-converting enzyme (ACE) inhibitors in a broad spectrum of patients with or at risk of cardiovascular disease. In particular, ACE inhibitors improve myocardial infarction- and stroke-free survival in patients with heart failure, impaired left ventricular function, acute myocardial infarction, stable coronary disease, stroke, hypertension, and diabetes. Part of this benefit is related to blood pressure reduction, but it is likely that other factors specific to ACE inhibitors also play a role. Since there are important pharmacological differences among ACE inhibitors, those with documented efficacy in specific indications should be chosen. In the combined analysis using individual data from 29 463 patients from ADVANCE, EUROPA, and PROGRESS, perindopril-based treatment has been shown to significantly reduce the risk of mortality and major cardiovascular events among patients with various levels of cardiovascular risk. Evidence for cardiovascular protection with perindopril was consistent in subgroups of patients with different clinical characteristics, concomitant medication use, and across all strata of baseline blood pressure.