Brugts JJ, et al. - There is a lack of clarity regarding the impacts of the combination of angiotensin converting enzyme inhibitors and beta-blockers on morbidity and mortality in patients with (cardio-)vascular disease. This current study retrospective analysis of three large perindopril outcome trials (ADVANCE, EUROPA, PROGRESS) indicated that the perindopril's beneficial cardioprotective impacts were additive to the background beta-blockers use.

Methods

• Researchers assessed clinical outcomes in 29,463 patients with vascular disease, in this retrospective pooled analysis of three large perindopril outcome trials (ADVANCE, EUROPA, PROGRESS).
• They performed multivariate Cox regression analyses in patients randomized to a perindopril-based regimen or placebo (treatment effect), and stratified data according to background beta-blocker treatment.
• The primary endpoint was a composite of cardiovascular mortality, non-fatal myocardial infarction, and stroke.

Results

• Findings demonstrated that the cumulative incidence of the primary endpoint over mean follow-up of 4.0 years (Sd 1.0) was significantly lower in the beta-blocker/perindopril group (9.6%; 545/5700 patients) as compared to beta-blocker/placebo (11.8%; 676/5718 patients) (p < 0.01).
• Researchers observed that adding perindopril to existing beta-blocker treatment reduced the relative risk of the primary endpoint by 20% (hazard ratio (HR) 0.80; 95% confidence interval (CI) 0.71–0.90), non-fatal myocardial infarction by 23% (HR 0.77; 95% CI 0.65–0.91), and all-cause mortality by 22% (HR 0.78; 95% CI 0.68–0.88) as compared to placebo.
• They did not find significant treatment benefit for stroke (HR 0.93; 95% CI 0.75–1.15).
• Data reported that significance was maintained for the primary endpoint and cardiovascular endpoints when data were further stratified by baseline hypertension.
• However, researchers observed the mortality benefit only in patients with hypertension with background beta-blocker use.