Low-Dose Perindopril and Indapamide Combination Compared with Losartan in the Treatment of Systemic Hypertension: A Randomized, Double-Blind Study

Background and Purpose: We compared the efficacy and safety of a low-dose combination of perindopril and indapamide (P/I, 2/0.625mg) with losartan (50mg) in Taiwanese patients with mild to moderate essential hypertension. Methods: Fifty patients with mild to moderate essential hypertension were randomized to receive either P/I or losartan once daily for a period of 12 weeks after a 2-week run-in phase. After 8 weeks treatment, if the office blood pressure (BP) was 140/9 mmHg or greater, the dose was doubled. Response and normalization rates (systolic blood pressure [SBP] less than 140mmHg and diastolic blood pressure [DBP] less than 90mmHg), extent of BP reduction, and proportion of patients necessitating increase of dose were compared both in full set and per protocol set analyses. Results: The baseline characteristics were comparable between the two patient groups. Normalization rate was significantly higher in the P/I group than in the losartan group (69.2% vs 41.7%) (p＜0.05); so was the response rate (80.8% vs 54.2%) (p＜0.05). Mean sitting SBP and sitting DBP fell by 15.2±10.0 and 9.5±4.7mmHg, respectively, in the P/I group (p＜0.001)and by 11.6±12.3 and 6.7±7.4mmHg, respectively, in the losartan group (p＜0.001). The falls were greater with P/I than those with losartan; however, these differences did not reach statistical significance. Both treatments were well tolerated, and laboratory examinations did not show any significant difference between two groups. Conclusions: A low-dose combination of P/I is more effective than losartan in the treatment of mild to moderate essential hypertension, with similar safety profiles. The results suggest that low-dose combination of P/I can be considered as an alternative for the first-line antihypertensive treatment.