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The treatment benefit of the ACE-inhibitor perindopril on top of beta-blocker therapy in patients with vascular disease

Session Poster session 2

Speaker Jasper Brugts

Event : ESC Congress 2016

  • Topic : preventive cardiology
  • Sub-topic : Risk Factors and Prevention
  • Session type : Poster Session

Authors : J J Brugts (Rotterdam,NL), M Bertrand (Lille,FR), R Ferrara (Ferrara,IT), K Fox (London,GB), S Macmahon (Sydney,AU), J Chalmers (Sydney,AU), M Simoons (Rotterdam,NL), H Boersma (Rotterdam,NL)

Authors:
J.J. Brugts1 , M. Bertrand2 , R. Ferrara3 , K. Fox4 , S. Macmahon5 , J. Chalmers5 , M. Simoons1 , H. Boersma1 , 1Erasmus Medical Center - Rotterdam - Netherlands , 2Hospital Regional University of Lille - Cardiological Hospital - Lille - France , 3University of Ferrara, S. Anna Hospital - Ferrara - Italy , 4Royal Brompton Hospital - London - United Kingdom , 5University of Sydney - Sydney - Australia ,

Citation:
European Heart Journal ( 2016 ) 37 ( Abstract Supplement ), 339

Objective: Angiotensin-converting enzyme (ACE) inhibitors have been shown to reduce cardiovascular events and mortality in different groups of patients. As they are often combined in clinical practice to β-blockers, we undertook an analysis using individual data from ADVANCE, EUROPA, and PROGRESS to determine the benefit of the combination of β-blockers with perindopril in patients with cardiovascular disease or at high risk of cardiovascular disease.

Design and method: In patients participating in the ADVANCE, EUROPA and PROGRESS trials which were randomized to an ACE-inhibitor based regimen or placebo, we identified all patients who received β-blocker at baseline. We studied the effect of perindopril on top of β-blockers on cardiovascular outcomes and mortality with a multi-variate Cox regression analysis.

Results: At baseline, 39% of patients in the three studies received beta-blocker (n=11 418 among 29 463 patients). Blood pressure reduction during the run-in period was similar between patients receiving perindopril on top of β-blocker compared with patients receiving perindopril without β-blocker at baseline (respective SBP/DBP reduction of -7.9/-3.6 mm Hg and -8.8/-4.0 mm Hg). The composite endpoint of cardiovascular mortality, non-fatal myocardial infarction and stroke was significantly reduced by 20% in the group of patients receiving β-blocker/perindopril compared with those with β-blocker/placebo (HR 0.80, 95% CI: 0.71–0.90). In addition, the benefit on this composite endpoint was similar whether patients were hypertensive (HR 0.77, 95% CI: 0.66–0.89) or not hypertensive (HR 0.84, 95% CI: 0.71–1.00), P interaction ns. Other endpoints such as non-fatal myocardial infarction (HR 0.77, 95% CI: 0.65–0.91), cardiovascular mortality (HR 0.73, 95% CI: 0.61–0.85) and all-cause mortality (HR 0.78, 95% CI: 0.68–0.88) were also significantly reduced in the β-blocker/perindopril group vs β-blocker/placebo.

Conclusions: Addition of perindopril to β-blocker in a broad spectrum of patients with vascular disease or high risk of vascular disease significantly improves survival and lowers the risk of myocardial infarction.

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