SUPER Trial (Superiority of 24-hour Antihypertensive Effectiveness of Perindopril in Patients with Mild to Moderate Hypertension) Formerly Treated with Enalapril

Overview

The primary objective of the 3-month SUPER trial was to confirm the effectiveness of treatment with the ACE inhibitor perindopril, 4 mg o.d., in patients formerly treated with enalapril in monotherapy administered only o.d. for at least three months - patients with mild to moderate hypertension and inadequate 24-hour control of the blood pressure assessed by BP measured at home.Perindopril led to normalization of the blood pressure at the end of the dosage period in more than 50% patients previously treated with enalapril administered only o.d. who had a normalized casual blood pressure, however, after 24 hours the blood pressure was not controlled satisfactorily. Perindopril treatment was well tolerated by the patients.Enalapril must be administered b.i.d. There are ACE inhibitors which can be administered o.d. but enalapril is not among them. They include e.g. perindopril, ramipiril, trandolapril, fosinopril and others.The screening part of the trial proved that enalapril monotherapy administered b.i.d. was the treatment received by 192, i.e. 32.7% of all screened patients. Of these 191 patients 32.5% had a controlled casual blood pressure (>140/90 mm Hg) and 129 (67.5%) had after enalapril monotherapy administered b.i.d. an uncontrolled BP (i.e. the BP was not lower than 140/90 mm Hg). It is of interest that a significant part of these patients was treated for a prolonged period by enalapril monotherapy. From this ensues that combined treatment of hypertension is little used by some general practitioners. As to ACE inhibitor in case of its ineffectiveness a small dose of thiazide diuretic or long-acting calcium channel blocker can be added.

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