Abstract 5066: The Treatment Effect of Perindopril is Consistent in All Patients with Vascular Disease or High Risk of Vascular Disease: A Combined Analysis of Three Perindopril Trials
The beneficial effect of the ACE-inhibitor perindopril has been demonstrated in large placebo-controlled clinical trials consisting of patients with stable CAD without overt heart failure (EUROPA), history of stroke (PROGRESS) and diabetes mellitus (ADVANCE). EUROPA investigated the effect of perindopril 8 mg during a mean follow-up of 4.2 years. PROGRESS investigated a perindopril 4mg/indapamide regimen during 4 years of follow-up and ADVANCE studied a perindopril 4 mg/indapamide regimen during 4.3 years of follow-up. In the three trials, mean blood pressure reduction was respectively, 5/2 mmHg, 9/4 mmHg and 6/2 mmHg. In all three trials, perindopril significantly reduced major cardiovascular events independent of baseline blood pressure levels. For this meta-analysis, we analyzed the treatment effect of the three trials combined on the shared endpoints of all-cause mortality and cardiovascular mortality & MI. Table 1⇓ shows an analysis of three perindopril trials (EUROPA, PROGRESS and ADVANCE). When these findings were combined (n=29493), perindopril significantly reduced all-cause mortality (OR 0.89, 95% CI 0.82– 0.97), and cardiovascular mortality, MI (OR 0.82, 95% CI 0.74 – 0.90). This combined analysis shows that perindopril reduced cardiovascular events by 11–18% irrespective of risk level or the type of patients, which is in line with prior meta-analyses and risk models. This treatment benefit by perindopril is consistent among all patients with vascular disease or high risk of vascular disease.