[pp.01.18] comparison of a new first-line treatment versus different first-line strategies using 24-hour ambulatory blood pressure monitoring

Objective: 24-hour ambulatory blood pressure measurement (ABPM) is superior to office blood pressure measurement (OBPM) in assessing the blood pressure (BP) lowering efficacy of antihypertensive medication. ABPM was used to assess the efficacy of a new first-line treatment recently approved in Europe (perindopril/amlodipine (P/A) 3.5 mg/2.5 mg and P/A 7 mg/5 mg) versus a range of first-line monotherapy strategies. Design and method: ABPM data were analyzed in 886 hypertensive subdivided into different therapeutic subgroups from three international, double-blind, parallel-group, randomized controlled trials. P/A 3.5/2.5 and 7/5 was compared to a range of first-line treatment strategies with an angiotensin receptor blocker (ARB) at 1 month and at 3 months, and with an angiotensin converting enzyme inhibitor (ACEi) at 2 months. Results: In these comparisons, P/A demonstrated superior BP-lowering efficacy on ABPM. After 1 month, P/A 3.5/2.5 (n = 67) there was a greater reduction from baseline in mean 24-hour systolic BP (SBP)/diastolic BP (DBP): -11.3 ± 10.5/-6.4 ± 6.3 mmHg (P < 0.002), in comparison with irbesartan 150 mg (n = 77): -6.7 ± 8.4/-3.6 ± 5.2 mmHg (P < 0.006). After 2 months, P/A 3.5/2.5 (n = 174) there was a greater decrease in mean 24-hour SBP/DBP (-8.5 ± 11.8/-5.8 ± 8.3; P < 0.001) than perindopril 5 mg (n = 187) (-4.9 ± 12.2/-3.6 ± 7.8; P < 0.001), estimate of the difference: -3.8/-2.4 mmHg. After 3 months, the mean 24-hour SBP/DBP reduction was -13.3 ± 10.3/-8.1 ± 6.6 mmHg and -9.1 ± 10.2/-6.0 ± 6.5 mmHg for patients on P/A 3.5/2.5 and on P/A 7/5 (n = 214) and for patients on valsartan 80 mg or valsartan 80 mg and 160 mg (n = 167), respectively (estimate of the difference -2.3; p < 0.001). When the treatment was prolonged to 6 months, the mean 24-hour SBP/DBP reduction was also significantly greater with the first-line single-pill strategy (-12.5 ± 11.1/-7.6 ± 7.3 mmHg vs. -9.2 ± 11.7/-6.2 ± 7.4 mmHg, estimate of the difference: -1.9; P = 0.007). No difference in safety profile was observed with any of the different monotherapy strategies. Conclusions: The new first-line single-pill perindopril/amlodipine strategy produces greater clinically relevant reductions in 24-hour SBP/DBP than various other first-line strategies, without any safety concern.