Contribution of perindopril to cardiology: 20 years of success

Cardiovascular risk factors such as hypertension and diabetes are known to initiate a chain of events that include oxidative stress, endothelial dysfunction, and vascular remodelling, and that if left to progress unchecked, will eventually culminate in end-stage cardiovascular disease. Perindopril is a long-acting lipophilic inhibitor of tissue angiotensin-converting enzyme (ACE) that has been studied in a variety of patient populations, ranging from those with hypertension to more advanced-stage cardiovascular disease. Although the role of ACE inhibitors is well established for patients with hypertension or heart failure, large morbidity–mortality trials have proved the efficacy of perindopril in a comparatively wide range of patients at risk of cardiovascular events, including patients with a history of stroke or transient ischaemic attack, irrespective of whether hypertension was present, and patients with stable coronary artery disease without heart failure or substantial hypertension. In addition, relative to a standard antihypertensive regimen based on a β-blocker/diuretic, a calcium antagonist/perindopril-based regimen has been shown to provide more effective broad-spectrum prevention of cardiovascular events in hypertensive patients. Early studies revealed that, in addition to sustained 24 h antihypertensive activity with once-daily dosing, perindopril is able to reverse arterial remodelling in hypertensive patients. Furthermore, subanalyses of data from morbidity–mortality trials have shown that reversal of abnormal endothelial function and reductions in central aortic pressure may help to account for benefits observed with perindopril that extend beyond those expected from reductions in brachial blood pressure alone. In summary, although it is already a well-established antihypertensive drug, pivotal clinical trials are still helping to unravel the true potential of perindopril across the cardiovascular continuum.