A well-powered study of 333 patients in 20 centers compared the effect of perindopril 8 mg once daily and a matching placebo on flow-mediated vasodilation (FMD) at 36 months as a measure of endothelial function in the brachial artery of patients with stable coronary artery disease and no clinical heart failure. This was a pre-specified substudy of the larger EUROPA study, previously reported.°Dr. Michiel Bots°of the University of Utrecht in the Netherlands presented this substudy at the European Hypertension meeting in Milan.
At baseline, the mean FMD was 2.7%. In the perindopril group, the FMD increased from 2.6% to 3.3% at 36 months, whereas in the placebo group it increased from 2.8% to 3.0%. The rate of change in endothelial function over the study period was 0.14% in the perindopril group (p<0.05), while in the placebo group it was 0.02% (p=0.74). The difference in the rate of change in endothelial function between the two groups was 0.12% (p=0.07). A 20% improvement in endothelial function was seen at 36 months, similar to the event rates in the EUROPA study.
The mean age of the patients was 66 years, and at baseline they were well matched, except the patients in the placebo group had a greater history of chest pain and positive exercise test (15.7% placebo, 9.6% perindopril), and more women in the perindopril group (21% vs 12% placebo group.