Short‐term effects of perindopril‐amlodipine vs perindopril‐indapamide on blood pressure control in sub‐Saharan type 2 diabetic individuals newly diagnosed for hypertension: A double‐blinded randomized controlled trial

Abstract

Poor blood pressure (BP) control contributes to complications in sub‐Saharan African (SSA) type 2 diabetic individuals. Experts have advocated the use of combination therapies for effective BP control in these patients. The suggested combinations should include a RAAS antagonist and either a CCB or a thiazide diuretic; however, their efficacy is yet to be established in SSA. We investigated the short‐term effects of two combination therapies on BP control in SSA type 2 diabetic individuals. This was a double‐blinded randomized controlled trial conducted at the Yaoundé Central Hospital (Cameroon) from October 2016 to May 2017. We included type 2 diabetic patients, newly diagnosed for hypertension. After baseline assessment and 24‐hour ABPM, participants were allocated to receive either a fixed combination of perindopril + amlodipine or perindopril + indapamide for 42 days. Data analyses followed the intention‐to‐treat principle. We included fifteen participants (8 being females) in each group. Both combinations provided good circadian BP control after 6 weeks with similar efficacy. Twenty‐four‐hour SBP dropped from 144 to 145 mm Hg vs 128 to 126 mm Hg with perindopril‐amlodipine and perindopril‐indapamide, respectively (P = 0.003 for both groups). Twenty‐four‐hour DBP dropped from 85 to 78 mm Hg (P = 0.013) vs 89 to 79 mm Hg (P = 0.006) in the same respective groups. No significant adverse effect was reported. A fixed initial combination of perindopril‐amlodipine or perindopril‐indapamide achieved similar effective BP control after 6 weeks in SSA type 2 diabetic individuals with newly diagnosed hypertension. Therefore, these combinations can be used interchangeably in this indication.

Suboptimal blood pressure control and its associated factors among people living with diabetes mellitus in sub-Saharan Africa: a systematic review and meta-analysis

“…In people living with diabetes, the risk of developing CVD and life-threatening complications is determined by the degree of control of hypertension. However, hypertension is often inadequately controlled, and the cardiovascular complications in SSA diabetic individuals are attributed to suboptimal blood pressure control [ 26 , 62 ]. Nevertheless, there is a paucity of data on the pooled prevalence and associated factors of suboptimal blood pressure control.…”

“…In a longitudinal cohort study of 30,228 diabetic patients, only 43 and 30% of European American and African American diabetic hypertensive patients, respectively, demonstrated a target blood pressure of 130/80 mmHg [ 23 ]. In SSA, rates of BP control range between 11 and 35% [ 24 , 25 ], and the cardiovascular complications in this region diabetic individuals are attributed to the suboptimal blood pressure control [ 26 ]. A study carried out in six specialized diabetes care centers of six SSA showed an overall suboptimal BP control in T2DM individuals despite adherence to guidelines [ 25 ].…”

Poor blood pressure control and its associated factors among peoples living with Diabetes Mellitus in sub-Saharan Africa: A Systematic Review and Meta-analysis

“…In peoples living with diabetes, the risk of developing CVD and life-threatening complications is determined by the degree of control of hypertension. However, the rate of control of hypertension is often inadequate and the cardiovascular complications in SSA diabetic individuals are attributed to poor blood pressure control (14,27,68). This systematic review and meta-analysis estimated the pooled prevalence and associated factors of poor blood pressure control among peoples living with diabetes mellitus in sub-Saharan Africa.…”

“…In a longitudinal cohort study of 30,228 diabetic patients, only 43 and 30% of European American and African American diabetic hypertensive patients, respectively, demonstrated a target blood pressure of 130/80 mmHg (24). In SSA rates of BP control range between 11 and 35% (25,26) and the cardiovascular complications in this region diabetic individuals are attributed to poor blood pressure control (27). A study carried out in six specialized diabetes care centers of six SSA showed an overall poor BP control in T2DM individuals despite adherence to guidelines (26).…”

Utility of fixed‐dose single tablet antihypertensive drug combinations in Cameroonians with type 2 diabetes and newly diagnosed hypertension

“…In this issue of the journal, Sobngwi et al from Yaounde, Cameroon, have published a short‐term efficacy and tolerability study, comparing two single tablet fixed‐dose combination medicines in individuals with type 2 diabetes mellitus and newly diagnosed hypertension.…”