ASCOT
Renin
Ang I
X
Activation of a1R (VSMC) CCB
ACEI CCB
Ca++
Ang II
X
VSMC
X
Vasoconstriction Reduced Na+ scrtion
Vasodilatation
Increased secretion of Na+ and water
BP
Perindopril+Amlodipine
Bahl UK. Fixed dose perindopril and amlodipine in moderate-to-severe hypertension. 14th World Congress of Heart Disease 2008, Toronto, Canada.
BP Reduction
Whatever the profile of hypertensive patients
Perindopril+Amlodipine
BP Reduction
In patients uncontrolled on monotherapy
Perindopril+Amlodipine
BP Reduction
In patients uncontrolled on combinations
Perindopril+Amlodipine
n= 1 250
n= 19 342
SBP
0
DDP
0
SBP
DDP
-10
-10
-20
-20
-23
-30
-30
-27
-40
-40
-42
BP decrease (mmHg)
-50
Amlodipine 5mg + Perindopril 5mg
-50
-44
Bahl UK. Fixed dose perindopril and amlodipine in moderate-to-severe hypertension. 14th World Congress of Heart Disease 2008, Toronto, Canada. Poulter NR, Chang CL, Dahlof B, Gupta AK, Sever PS, Wedel H, on behalf of the ASCOT investigators. Evaluating the efficacy of the stepped-care anti-hypertensive strategies used in the Anglo-Scandinavian Cardiac Outcomes Trial BP Lowering Arm (ASCOT-BPLA). Hypertension. 2008. OS11/1.
10
11
100 100 75 63 55 60 38 80 50 78 70 70 69 70
60 80 100
12
/Perindopril
1.Rothwell PM et al. Lancet Neurol. 2010;9(5):469-480 2. Rothwell PM et al. Lancet. 2010;375:938-948. 3. Rothwell PM et al. Lancet. 2010;375:895905.
13
14
15
Outgoing wave = blood exiting the heart via aorta Reflected wave = back wave of blood returning to the heart. This is dependent on the stiffness of the artery.
16
Outgoing wave remains the same Reflected wave will travel back more quickly due to arterial stiffness. This means that it will arrive back at the heart earlier. Aortic root pressure will be higher & thus the pressure at the key organs too
Figure 1
17
18
140
Transfer function
140
70 Radial
70
Central Aortic
19
Trial Overview
To examine the difference between recommended betablocker/thiazide versus newer Perindopril/Amlodipine BP regimen on central aortic BP
20
Perindopril
21
/Perindopril
/Perindopril
23
Ferrari R. Optimizing the treatment of hypertension and stable coronary artery disease: clinical evidence for fixed-combination perindopril/amlodipine. Curr Med Res Opin. 2008;24:3543-3557.
24
Ferrari R. Optimizing the treatment of hypertension and stable coronary artery disease: clinical evidence for fixed-combination perindopril/amlodipine. Curr Med Res Opin. 2008;24:3543-3557.
25
Amlodipine alone
Perindopril-Amlodipine
Messerli FH, et al. Am J Cardiol. 2000;86(11):1182-1187 Ferrari, R. Current Med. Research & Opinion, 2008, 24 (12), 3543-3557
26
270 250
247
Number of patients
- 52%
M0
Perindopril-Amlodipine
M1
M3
28
arachidonic acid
stim. PLAz inhibit
PGEz
stim. pulm. sensory C fibers
coughing
inhibit
Perindopril in EUROPA study cough in 2.7% Perind + amlo in STRONG Study cough in 1.5%
29
Perindopril + Amlodipine
30
Perindopril + Amlodipine is
31
Thank you
32
33
34