Perindopril a class of ACE-inhibitor,proven more superior and evidence in favour of CVD Mortality and morbidity including strokes compare to Ramipril with same class of drug

1. C a r b o x y l
g r o u p
P y r o l
g r o u p
C H 2 C H 3
C O O H
C O O C H2 5
NC OC HN HC HC H 2
Chemical Structure ofChemical Structure of
RamiprilRamipril

2. Chemical Structure of PerindoprilChemical Structure of Perindopril

3. Clinical characteristicsClinical characteristics
HOPE vs. EUROPAHOPE vs. EUROPA
2969Lipid – lowering therapy (%)
3962Beta – blockers (%)
7692Antiplatelet treatment (%)
113.3Previous stroke (%)
43.555Previous revascularization (%)
5365Previous MI (%)
38.412Diabetics (%)
4727Hypertensive (%)
CAD
Non CAD
CADPopulation
Ramipril
10 mg/day
Perindopril 8
mg/day
ACEI dosage
73.385Male (%)
6660Age (years)
929712218N
HOPEEUROPA
22%20%Relative Risk Redn. in Pri. End Point

4. HOPE vs. EUROPAHOPE vs. EUROPA
Study populationStudy population HOPEHOPE EUROPAEUROPA
Age (yrs)Age (yrs) 6666 6060
Female gender (%)Female gender (%) 2727 1515
Known CAD (%)Known CAD (%) 8080 100100
Previous MI (%)Previous MI (%) 5353 6565
PVD (%)PVD (%) 4343 77
Stroke/TIA (%)Stroke/TIA (%) 1111 33
Diabetes (%)Diabetes (%) 3838 1212
Hypertension (%)Hypertension (%) 4747 2727
Hypercholesterolemia(%)Hypercholesterolemia(%) 6666 6363

5. BaselineBaseline HOPEHOPE EUROPAEUROPA
AntiplateletAntiplatelet
drugs*drugs*
76 %76 % 92 %92 %
ββ-blockers-blockers 39 %39 % 62 %62 %
Lipid loweringLipid lowering
drugsdrugs
29 %29 % 58 %58 %
* Mostly aspirin* Mostly aspirin
More extensive treatment in EUROPA than in HOPEMore extensive treatment in EUROPA than in HOPE
HOPE vs. EUROPAHOPE vs. EUROPA

6. HOPEHOPE EUROPAEUROPA
Total mortalityTotal mortality 12.2%12.2% 7.4 %7.4 %
CV mortalityCV mortality 8.1%8.1% 4.4%4.4%
Q wave MIQ wave MI 3.2%3.2% 2.1%2.1%
Major annual event rates : 50 to 80 %Major annual event rates : 50 to 80 % higherhigher in HOPEin HOPE
Placebo outcomes standardised for 4.5 yrs FUPlacebo outcomes standardised for 4.5 yrs FU
HOPE vs.HOPE vs.
EUROPAEUROPA

7. ConclusionConclusion
 EUROPA is the only ACE inhibitor trial done in trueEUROPA is the only ACE inhibitor trial done in true
CAD patients across all age groups, even in theCAD patients across all age groups, even in the
young patients, below 55 years.young patients, below 55 years.
 In EUROPA there were all kinds of CAD patients, atIn EUROPA there were all kinds of CAD patients, at
various levels of risk.various levels of risk.
 All patients in EUROPA had documented CAD.All patients in EUROPA had documented CAD.
 In EUROPA all patients were optimally controlledIn EUROPA all patients were optimally controlled
with other modern preventive therapies like Betawith other modern preventive therapies like Beta
blockers, Aspirin and Statins.blockers, Aspirin and Statins.
 And of course, this is the largest study everAnd of course, this is the largest study ever
performed in patients with CAD.performed in patients with CAD.
 In fact,the patients in EUROPA are similar to theIn fact,the patients in EUROPA are similar to the
patients we see in our day-to-day practice unlike inpatients we see in our day-to-day practice unlike in
HOPE with Ramipril.HOPE with Ramipril.

8. ConclusionConclusion
•• No doubt ramipril is a good drug,No doubt ramipril is a good drug,
butbut COVERSYLCOVERSYL scores abovescores above
ramipril in certain areas:ramipril in certain areas:
 Better 24 hours B.P. controlBetter 24 hours B.P. control
 Better safety profile – less coughBetter safety profile – less cough
 Proven data in all types of CAD patientsProven data in all types of CAD patients
 Proven data on secondary strokeProven data on secondary stroke
prevention (PROGRESS)prevention (PROGRESS)
 Proven data on diabeticProven data on diabetic
endpoints(ADVANCE)endpoints(ADVANCE)