title: Perindopril/indapamide combination more effective than enalapril in reducing blood pressure and left ventricular mass: the PICXEL study.
abstract: OBJECTIVE
  Few data are available comparing the effects of monotherapy and combination therapy on target organ damage. The PICXEL study compared the efficacy of a strategy based on first-line combination with perindopril/indapamide versus monotherapy with enalapril in reducing left ventricular hypertrophy (LVH) in hypertensive patients.
  
  
  METHODS
  In this 1-year multicentre randomized double-blind study, patients received an increasing dosage of perindopril/indapamide (n = 284) or enalapril (n = 272). Changes in blood pressure and echocardiographic measures of LVH were assessed from baseline to the end of treatment. Reading of the echocardiograms was central and blinded for therapy, patient and sequence.
  
  
  RESULTS
  Systolic and diastolic blood pressure decreased significantly more in the perindopril/indapamide than in the enalapril group (P < 0.0001 and P = 0.003). The left ventricular mass index decreased by 13.6 +/- 23.9 g/m(2) (mean +/- SD) with perindopril/indapamide (P < 0.0001) and 3.9 +/- 23.9 g/m(2) with enalapril (P < 0.005); these decreases were significantly different (P < 0.0001). The left ventricular internal diameter, posterior and interventricular septal wall thickness decreased significantly with perindopril/indapamide (P < or = 0.0001); the interventricular septal wall thickness decreased significantly with enalapril (P < 0.001). Both treatments were well tolerated.
  
  
  CONCLUSIONS
  A strategy based on first-line combination with perindopril/indapamide achieved better blood pressure decrease with a significantly greater degree of LVH reduction than a strategy based on monotherapy with enalapril in hypertensive patients with LVH.
authors.affiliation: Göteborg University, Sweden. bjorn.dahlof@scri.se
authors.forename: Björn
authors.initials: B
authors.lastname: Dahlöf
authors.forename: Philippe
authors.initials: P
authors.lastname: Gosse
authors.forename: Pascal
authors.initials: P
authors.lastname: Guéret
authors.forename: Olivier
authors.initials: O
authors.lastname: Dubourg
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Simone
authors.forename: Roland
authors.initials: R
authors.lastname: Schmieder
authors.forename: Yuri
authors.initials: Y
authors.lastname: Karpov
authors.forename: Juan
authors.initials: J
authors.lastname: García-Puig
authors.forename: Lajos
authors.initials: L
authors.lastname: Matos
authors.forename: Peter W
authors.initials: PW
authors.lastname: De Leeuw
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Degaute
authors.forename: Dieter
authors.initials: D
authors.lastname: Magometschnigg
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy* / Q000503:physiopathology; D007190:Indapamide / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000009:adverse effects / Q000627:therapeutic use*; D011188:Potassium / Q000097:blood; D012044:Regression Analysis; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D007190:Indapamide; D011188:Potassium; D020913:Perindopril