Blood Pressure Normalization by Fixed Perindopril/indapamide Combination in Hypertensive Patients with or Without Associate Metabolic Syndrome: Results of the OPTIMAX 2 Study

Overview

Journal Vasc Health Risk Manag

Publisher Dove Medical Press

Specialty Cardiology & Vascular Diseases

Date 2008 Jun 20

PMID 18561520

Citations 3

Authors

Jean-Jacques Mourad

Dulce Lameira

Pierre-Jean Guillausseau

Affiliations

Soon will be listed here.

Abstract

The aim of the observational pharmaco-epidemiological study Optimax II was to seek whether the pre-existence of a metabolic syndrome (MS) defined by the NCEP-ATP III criteria impacts blood pressure (BP) control in hypertensive patients receiving a fixed perindopril/indapamide combination therapy. The primary objective of the study was to compare in patients with and without MS the rate of BP control defined as a systolic BP < or = 140 mmHg and a diastolic BP < or = 90 mmHg. Patients were prospectively included and the follow-up lasted 6 months. The study population consisted of 24,069 hypertensive patients (56% men; mean age 62 +/- 11 years; 18% diabetics; mean BP at inclusion 162 +/- 13/93 +/- 9 mmHg). MS was found in 30.4% of the patients (n = 7322): 35.2% women and 20.1% men. Three therapeutic subgroups were constituted: Group A, previously untreated, received the combination therapy as initial treatment; Group B, previously treated but with unsatisfactory results and/or treatment intolerance, had its previous treatment switched to perindopril/indapamide; and Group C, previously treated, with good treatment tolerance but uncontrolled BP, received the study treatment in adjunction to the previous one. The normalization rate was 70.3% in group A, 68.4% in Group B, and 64.1% in Group C (p < 0.0001). The pre-existence of MS did not show any significant influence on these rates since BP lowering was -22.7 +/- 13.7 (SBP) and -12.0 +/- 10.0 mmHg (DBP) in patients without MS and 22.6 +/- 13.3 (SBP) and -12.1 +/- 9.7 (DBP) in those with MS. The results of this study show a significant effect of perindopril/indapamide treatment on systolic BP lowering, whatever the treatment status: initiation, switch, or adjunctive therapy, and independently from the presence or not of MS. This effect may be related to the specific vascular effect of the perindopril/indapamide combination, which has recently demonstrated in the ADVANCE trial its ability to reduce mortality, and cardiovascular and renal complications in diabetic patients.

Citing Articles

Full-dose Perindopril/Indapamide in the Treatment of Difficult-to-Control Hypertension: The FORTISSIMO Study.

Karpov Y Clin Drug Investig. 2016; 37(2):207-217.

PMID: 27878562 DOI: 10.1007/s40261-016-0479-7.

Complementary mechanisms of action and rationale for the fixed combination of perindopril and indapamide in treating hypertension - update on clinical utility.

Barrios V, Escobar C Integr Blood Press Control. 2011; 3:11-9.

PMID: 21949617 PMC: 3172067. DOI: 10.2147/ibpc.s6636.

Update on the metabolic syndrome: hypertension.

Reynolds K, Wildman R Curr Hypertens Rep. 2009; 11(2):150-5.

PMID: 19278605 DOI: 10.1007/s11906-009-0026-5.

References

Navarro J, Redon J, Cea-Calvo L, Lozano J, Fernandez-Perez C, Bonet A . Metabolic syndrome, organ damage and cardiovascular disease in treated hypertensive patients. The ERIC-HTA study. Blood Press. 2007; 16(1):20-7. DOI: 10.1080/08037050701217817. View

Ajjan R, Carter A, Somani R, Kain K, Grant P . Ethnic differences in cardiovascular risk factors in healthy Caucasian and South Asian individuals with the metabolic syndrome. J Thromb Haemost. 2007; 5(4):754-60. DOI: 10.1111/j.1538-7836.2007.02434.x. View

Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G . 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007; 25(6):1105-87. DOI: 10.1097/HJH.0b013e3281fc975a. View

Garcia-Puig J, Ruilope L, Luque M, Fernandez J, Ortega R, Dal-Re R . Glucose metabolism in patients with essential hypertension. Am J Med. 2006; 119(4):318-26. DOI: 10.1016/j.amjmed.2005.09.010. View

Ferrara L, Guida L, Ferrara F, De Luca G, Staiano L, Celentano A . Cardiac structure and function and arterial circulation in hypertensive patients with and without metabolic syndrome. J Hum Hypertens. 2007; 21(9):729-35. DOI: 10.1038/sj.jhh.1002222. View

Ferrara L, Cardoni O, Mancini M, Zanchetti A . Metabolic syndrome and left ventricular hypertrophy in a general population. Results from the Gubbio Study. J Hum Hypertens. 2007; 21(10):795-801. DOI: 10.1038/sj.jhh.1002232. View

Asmar R, London G, ORourke M, Safar M . Improvement in blood pressure, arterial stiffness and wave reflections with a very-low-dose perindopril/indapamide combination in hypertensive patient: a comparison with atenolol. Hypertension. 2001; 38(4):922-6. DOI: 10.1161/hy1001.095774. View

Alberti K, Zimmet P, Shaw J . The metabolic syndrome--a new worldwide definition. Lancet. 2005; 366(9491):1059-62. DOI: 10.1016/S0140-6736(05)67402-8. View

Ford E, Giles W, Dietz W . Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002; 287(3):356-9. DOI: 10.1001/jama.287.3.356. View

10.

Balkau B, Charles M . Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Diabet Med. 1999; 16(5):442-3. DOI: 10.1046/j.1464-5491.1999.00059.x. View

11.

Hu G, Qiao Q, Tuomilehto J, Balkau B, Borch-Johnsen K, Pyorala K . Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women. Arch Intern Med. 2004; 164(10):1066-76. DOI: 10.1001/archinte.164.10.1066. View

12.

Leoncini G, Ratto E, Viazzi F, Vaccaro V, Parodi D, Parodi A . Metabolic syndrome is associated with early signs of organ damage in nondiabetic, hypertensive patients. J Intern Med. 2005; 257(5):454-60. DOI: 10.1111/j.1365-2796.2005.01468.x. View

13.

Choi K, Kim S, Kim Y, Choi D, Baik S, Lee J . Prevalence and cardiovascular disease risk of the metabolic syndrome using National Cholesterol Education Program and International Diabetes Federation definitions in the Korean population. Metabolism. 2007; 56(4):552-8. DOI: 10.1016/j.metabol.2006.12.003. View

14.

Mule G, Nardi E, Cottone S, Cusimano P, Incalcaterra F, Palermo A . Relationship of metabolic syndrome with pulse pressure in patients with essential hypertension. Am J Hypertens. 2007; 20(2):197-203. DOI: 10.1016/j.amjhyper.2006.07.016. View

15.

Mule G, Cottone S, Nardi E, Andronico G, Cerasola G . Metabolic syndrome in subjects with essential hypertension: relationships with subclinical cardiovascular and renal damage. Minerva Cardioangiol. 2006; 54(2):173-94. View

16.

Mule G, Nardi E, Cottone S, Cusimano P, Volpe V, Piazza G . Influence of metabolic syndrome on hypertension-related target organ damage. J Intern Med. 2005; 257(6):503-13. DOI: 10.1111/j.1365-2796.2005.01493.x. View

17.

Qiao Q, Gao W, Zhang L, Nyamdorj R, Tuomilehto J . Metabolic syndrome and cardiovascular disease. Ann Clin Biochem. 2007; 44(Pt 3):232-63. DOI: 10.1258/000456307780480963. View

18.

Barrios V, Escobar C, Calderon A, Llisterri J, Alegria E, Muniz J . [Adequacy of the treatment of hypertensive patients with metabolic syndrome]. Med Clin (Barc). 2007; 128(17):647-51. DOI: 10.1157/13102050. View

19.

Kelishadi R, Derakhshan R, Sabet B, Sarraf-Zadegan N, Kahbazi M, Sadri G . The metabolic syndrome in hypertensive and normotensive subjects: the Isfahan Healthy Heart Programme. Ann Acad Med Singap. 2005; 34(3):243-9. View

20.

Rodilla E, Gonzalez C, Costa J, Pascual J . [New definition of metabolic syndrome: does it have the same cardiovascular risk?]. Rev Clin Esp. 2007; 207(2):69-74. DOI: 10.1157/13100198. View