Perindopril for improving cardiovascular events

In a recent review in Vascular Health and Risk Management Wang et al state that "In mainly placebo-controlled cardiovascular (CV)-outcome studies in patients with hyperten sion, CV benefits with perindopril were associated with large reductions in BP." 1 However, perindopril in the European Trial on Reduction of Cardiac Events With Perindopril in Stable Coronary Artery Disease (EUROPA) study significantly reduced major cardiovascular events despite a small reduction (approximately 4 mmHg) in systolic blood pressure from baseline. 2,3 Additionally, the average baseline blood pressure in the EUROPA was just 137/82 mmHg, and in those without hypertension, perindopril still provided a 20% reduction in the combined endpoint of cardiovascular death, myocardial infarction, and cardiac arrest. 4,5 In fact, patients receiving perindopril with a baseline systolic blood pressure of ,120 mmHg had the greatest reduction in the primary event. 6 PERindopril-Thrombosis, InflammatioN, Endothelial dysfunction and Neurohormonal activation Trial (PERTINENT), a sub study of EUROPA, also showed that perindopril improves endothelial function, which the authors concluded may have provided the benefit and not blood pressure reduction per se. 7 Thus, the notion that perindopril is only effective in hypertensive patients, and only when large reductions in blood pressure occur, is not supported by the literature.