Efficacy and safety of single-pill combination perindopril/amlodipine switched from combinations of other renin-angiotensin system inhibitors and calcium channel blockers: results from ESPRIT trial

Abstract Background Renin-angiotensin system inhibitors (RASi) and calcium channel blockers (CCBs) are both guideline-recommended antihypertensive medications. Single-pill combination (SPC) potentially improve adherence and efficacy. Purpose To use the ESPRIT trial data to compare the antihypertensive efficacy and safety of PER/AML with a free combination of one RASi and one CCB. Methods We included participants who received free combinations of RASi and CCBs, and switched to Perindopril/amlodipine (PER/AML) 10 mg / 5 mg. Investigators adjusted participants’ antihypertensive medications based on office BP measurement and study-group assignment. At each office visit, BP was measured three times using an electronic blood pressure monitor (Omron HBP-1100) and the mean value was used. We compared the BP level and control rates before the switch (baseline) and after the switch (3, 6, and 12 months). Additionally, eGFR changes and adverse events were evaluated at each visit. Results A total of 188 participants (mean BP, 132.4±12.5/74.3±9.8 mm Hg) were included; 86.7% were assigned to a target systolic BP (SBP) of 120 mm Hg. Before switching to PER/AML, 14.4% received only one RASi and one CCB, others also received other antihypertensive drugs. At 3, 6, and 12 months after switching to PER/AML treatment, the changes of SBP/DBP were -7.3/-3.6 mm Hg, -9.2/-3.7 mm Hg, and -7.4/-3.4 mm Hg, respectively (P0.001). The proportion of participants achieving BP 120/80 mm Hg increased from 14.4% at baseline to 47.3%, 55.9%, and 44.7% at 3, 6, and 12 months, with similar increases for targets of SBP 140 mm Hg and 130 mm Hg (all P0.05) (Table 1). Consistent SBP changes were observed at 6 and 12 months across subgroups of coronary heart disease, diabetes, or stroke (Table 2). During follow-up, eGFR initially decreased slightly and then gradually returned to baseline levels. The most frequently reported treatment-related adverse events were that already described for perindopril, i.e., cough. Conclusion In this sub-analysis of the ESPRIT study, switching to PER/AML from combinations of other RASi and CCBs significantly reduced BP and improved BP control rates for the different BP targets, regardless of comorbidities such as coronary heart disease, diabetes, or stroke. The treatment demonstrated a good safety profile.