Concomitant Treatment of Hypertensive Patients with Bisoprolol and Perindopril in Routine Clinical Practice: A Post Hoc Analysis of the CONFIDENCE II, PROTECT I, and PROTECT III Observational Studies

Abstract

Introduction The combination of angiotensin-converting enzyme inhibitors and beta-blockers is recommended in a wide range of patients with hypertension, including those with stable coronary artery disease and/or elevated heart rate. This post hoc analysis of three observational studies provides effectiveness and safety data on treatment with perindopril on top of bisoprolol-based therapy, in routine clinical practice. Methods Data were analyzed from three open-label, prospective, multicenter, observational studies of Canadian patients with mild-to-moderate hypertension, which shared the same inclusion and exclusion criteria, treatment duration, and primary outcome. This post hoc analysis focused on the subpopulation of patients treated with perindopril on top of bisoprolol-based therapy. All patients were followed for 16 weeks and underwent baseline, week 4, and week 16 visits. Primary outcomes were mean changes in blood pressure (BP) and proportion of patients achieving BP control (< 140/90 mmHg) in the full analysis set (FAS). Results A total of 845 patients (mean age 68.3 ± 11.3 years, mean baseline BP 151.5/86.0 mmHg) were analyzed in the FAS. After 16 weeks, mean SBP/DBP decreased by − 20.4/− 9.8 mmHg with statistically significant reductions observed at all visits in all three studies allowing 78% of patients to achieve the BP treatment goal. No statistically significant changes in heart rate were observed and no serious adverse events reported. The most frequent doses of bisoprolol and perindopril were 5 + 4 mg (34.9%), followed by 5 + 8 mg (16.9%), and 2.5 + 4 mg (12.5%). Conclusion The addition of perindopril on top of bisoprolol-based therapy in patients with mild-to-moderate hypertension was associated with significant reductions in BP compared with baseline and with achievement of BP targets in the majority of patients. The results suggest this strategy is safe and effective for use in routine clinical practice.

Effectiveness and Tolerability of Bisoprolol/Perindopril Single-Pill Combination in Patients with Arterial Hypertension and a History of Myocardial Infarction: The PRIDE Observational Study

“…A number of studies have provided real-world evidence to support the benefits of combining bisoprolol with perindopril [ 21 , 27 , 48 , 49 ]. The most recent data come from a post hoc analysis of three large Canadian observational studies [ 21 ].…”

“…A number of studies have provided real-world evidence to support the benefits of combining bisoprolol with perindopril [ 21 , 27 , 48 , 49 ]. The most recent data come from a post hoc analysis of three large Canadian observational studies [ 21 ]. The three studies all shared the same design, including the same inclusion and exclusion criteria, treatment duration (16 weeks), and primary outcome, which allowed the post hoc analysis to assess the effectiveness and safety of adding perindopril to bisoprolol-based therapy in patients with mild-to-moderate hypertension [ 21 ].…”

“…The most recent data come from a post hoc analysis of three large Canadian observational studies [ 21 ]. The three studies all shared the same design, including the same inclusion and exclusion criteria, treatment duration (16 weeks), and primary outcome, which allowed the post hoc analysis to assess the effectiveness and safety of adding perindopril to bisoprolol-based therapy in patients with mild-to-moderate hypertension [ 21 ]. The combination was associated with statistically significant reductions in blood pressure compared with baseline, and achievement of blood pressure goals in at least three out of four patients at study end.…”

“…Recent real-world data have confirmed the antihypertensive and antianginal benefits of a bisoprolol/perindopril combination in patients with hypertension and stable CAD [ 20 , 21 ]. The aim of the current observational study was to extend the previous observational data by evaluating the effectiveness of a beta-blocker-based SPC on blood pressure, heart rate, and anginal symptoms in a high-risk post-MI population with concomitant hypertension.…”