title: Efficacy and tolerability of fixed-dose combination of perindopril/indapamide in type 2 diabetes mellitus: PICASSO trial.
abstract: BACKGROUND
  Hypertension and type 2 diabetes mellitus (T2DM) synergistically deteriorate the vascular environment, making blood pressure reduction challenging, and substantially increasing cardiovascular risk.
  
  
  METHODS
  In the real-life, open-label, observational, PICASSO study, 9,257 hypertensive patients unsuccessfully treated with antihypertensives were switched to fixed-dose combination of perindopril 10 mg/indapamide 2.5 mg. In this subgroup analysis, we analyzed changes in blood pressure and laboratory parameters of 2,762 hypertensive patients with T2DM or pre-diabetes.
  
  
  RESULTS
  After 3 months of treatment, significant decreases in office blood pressure were noted in the whole cohort (-27.0±14.8/-12.7±9.8 mmHg; p<0.001). Significant decreases were also recorded in patients with grade 1 hypertension (19.2±10.0/-9.4±7.9 mmHg), grade 2 (29.2±10.9/-13.3±8.7 mmHg) and grade 3 (-45.1±15.4/-21.5±11.2 mmHg). Significant decreases in ambulatory blood pressure were also noted (n=93). In patients previously treated with angiotensin-converting enzyme inhibitor±hydrochlorothiazide or angiotensin receptor blocker±hydrochlorothiazide, mean 24-h blood pressure decreased by 23.4±13.9/11.5±9.7 and 22.3±8.7/10.4±13.2 mmHg, respectively (p<0.001). Treatment was well tolerated and the switch to treatment with perindopril/indapamide was associated with improvements in laboratory parameters.
  
  
  CONCLUSIONS
  Data from this diabetes subgroup analysis suggest that fixed combination of perindopril 10 mg/indapamide 2.5 mg should be routinely considered for the treatment of hypertension in diabetic patients who are unsuccessfully managed with other antihypertensive medications.
authors.affiliation: St. Imre University Teaching Hospital, Tétényi u. 12-16, Budapest, 1115, Hungary, hunghyp@t-online.hu.
authors.forename: Csaba
authors.initials: C
authors.lastname: Farsang
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D018660:Blood Pressure Monitoring, Ambulatory; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007190:Indapamide / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000627:therapeutic use*; D011236:Prediabetic State / Q000150:complications*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D004338:Drug Combinations; C494243:indapamide, perindopril drug combination; D007190:Indapamide; D020913:Perindopril