Angiotensin converting enzyme (ACE) inhibitors, plain. Perindopril.
Perindopril is an inhibitor of the enzyme that converts angiotensin I into angiotensin II (Angiotensin Converting Enzyme ACE). The converting enzyme, or kinase, is an exopeptidase that allows conversion of angiotensin I into the vasoconstrictor angiotensin II as well as causing the degradation of the vasodilator bradykinin into an inactive heptapeptide. Inhibition of ACE results in a reduction of angiotensin II in the plasma, which leads to increased plasma renin activity (by the feedback) and reduced secretion of aldosterone. Since ACE inactivates bradykinin, inhibition of ACE also results in the increased activity of circulating and local kallikrein-kinin systems (and thus also activation of the prostaglandin system). It is possible that this mechanism contributes to the blood pressure-lowering action of ACE inhibitors and is partially responsible for certain of their side effects (e.g. cough). Perindopril tert-butylamine acts through its active metabolite, perindoprilat. The other metabolites show no inhibition of ACE activity in experimental conditions.
Prevention of recurrent stroke in patients with the cerebrovascular diseases
Prevention of cardiovascular complications in patients with the documented stable coronary artery disease
The long-term treatment reduces the risk of myocardial infarction and heart failure (based on results from EUROPA study).
Stable coronary artery disease.
If an episode of unstable angina pectoris (major or not) occurs during the first month of perindopril treatment, a careful appraisal of the benefit/risk should be performed before treatment continuation.
ACE inhibitors may cause a fall in blood pressure. Symptomatic hypotension is rarely reported in uncomplicated hypertensive patients and is more likely to occur in patients who have been volume-depleted e.g. by diuretic therapy, dietary salt restriction, dialysis, diarrhea or vomiting, or who have severe renin-dependent hypertension.