Efficacy and tolerability of a fixed combination of bisoprolol and perindopril in the treatment of hypertensive patients after revascularization for acute coronary syndrome

Objective. To study the efficacy and tolerability of a fixed combination of bisoprolol and perindopril in the treatment of hypertensive patients after revascularization for acute coronary syndrome (ACS) at the third (outpatient) stage of cardiological rehabilitation. Design and methods . In total, 1004 patients who underwent coronary artery stenting due to ACS were followed-up by cardiologists after discharge from the vascular departments of hospitals in Omsk. Their data were analyzed after 6 months (lipids, blood pressure (BP), total mortality, hospitalization rate). Among them, 91 patients were not included in the physical cardiological rehabilitation program due to the non-target values of BP and heart rate (HR). All of them took free combinations of beta-blockers and angiotensin-converting enzyme (ACE) inhibitors. They were offered to change a free combination to a fixed one including bisoprolol and perindopril in individual doses (5/5, or 5/10, or 10/10 mg). We estimated the office BP, HR at three time points: at the start of therapy (1st visit, V1), after 4 weeks (V2) and after 12 weeks (V3). The BP variability and patients’ adherence to treatment were also assessed. Results. After 4 weeks of treatment by the fixed combination of bisoprolol and perindopril, BP and HR decreased: 92,0 % achieved target BP levels, while target HR was achieved in 95,4 %. At V3, after dose titration, target BP and heart rate were achieved in all patients. After 12 weeks of treatment, the variability of systolic BP (SBP) and diastolic BP (DBP) was normalized in 80,4 % and 88,1 %, respectively (p < 0,001). Individual target HR in patients with heart failure symptoms and/or angina pectoris was not achieved in 91,3 % respondents at V1, in 18,5 % at V2, in 4,6 % at V3. At V2, 50 people (54,9 %) were considered eligible for the individual physical rehabilitation. At V3, additional 38 (41,7 %) patients were re-evaluated as eligible for the physical rehabilitation program. Patients demonstrated improved adherence to treatment: from V1 to V2 the compliance increased up to 73,0 % (p < 0,01), at V3 — up to 78,0 % (p < 0,001). We assessed the intention to continue the treatment, the answers were the following: “I don’t know” — 2,4 %, “perhaps” — 40,7 %, “definitely” — 56,7 %. Conclusions. Our study demonstrate the need for a wider implementation of the fixed combination of bisoprolol and perindopril in management of hypertensive patients after ACS.