Evaluation of the Safety and Efficacy of Dual Therapy Perindopril/Amlodipine in the Management of Hypertension. A Systematic Review and Meta-Analysis

• Published in: High blood pressure & cardiovascular prevention 2022-11, Vol.29 (6), p.565-576
• Main Authors: Mostafa, Sadek, Shabana, Hosam, Khalil, Farag, Mancy, Ismail Mohamed El, Zedan, Hendawy Abdel-Moety, Elmoursi, Ahmed, Ramadan, Ibrahim Ghounim, Mohamed, Saad El Deen, Kassem, Arafat, Kamel, Islam Shawky
• Format: Article
• Language: English
• Subjects: Alcohol; Antihypertensives; Beta blockers; Blood pressure; Body mass index; Calcium; Cardiac arrhythmia; Cardiovascular disease; Data collection; Diabetes; Drug dosages; Edema; Health risks; Heart rate; Hypertension; Mortality; Pharmacovigilance; Polypharmacy; Software
• ISSN: 1120-9879; 1179-1985
• DOI: 10.1007/s40292-022-00544-3

IntroductionHypertension represent the commonest cause of death in 2017. Hypertension is classified into two types which are primary or essential hypertension and secondary hypertension. The perindopril–amlodipine combination showed a significant effect in reduction of the elevated BP and the cardiovascular complications.AimTo evaluate the efficacy and safety of a fixed-dose single-pill combination of perindopril–amlodipine in hypertensive patients.MethodsWe searched PubMed, Medline, SCOPUS, and Web of Science for relevant clinical trials. Quality appraisal was evaluated according to GRADE and we assessed the risk of bias using Cochrane’s risk of bias tool. We included the following outcomes: systolic blood pressure, diastolic blood pressure, pulse pressure, mean blood pressure, heart rate, cough, dizziness, headache, and peripheral edema. We performed the analysis of homogeneous data under the fixed-effects model, while analysis of heterogeneous data was analyzed under the random-effects model. We conducted a meta-regression according to the dose.ResultsWe included ten clinical trials. The pooled analysis showed that there was a significant reduction of the systolic blood pressure, diastolic blood pressure, pulse plessure, mean blood pressure, and heart rate after the the perindopril–amlodipine combination (MD = 18.96 [14.32, 23.60], P < 0.0001), (MD = 11.90 [8.45, 15.35], P < 0.0001), (MD = 8.44 [6.91, 9.97], P = 0.0001), (MD = 13.07 [5.86, 20.29], P = 0.0004), and (MD = 2.93 [0.89, 4.96], P = 0.005), respectively. The results of the meta-regression revealed that the efficacy is increased by increasing the dose (P < 0.001)ConclusionThe use of the perindopril–amlodipine combination had a significant effect on the reduction of SBP, DBP, mean blood pressure, pulse pressure, and HR.