Efficacy and safety of diuretics in combination with perindopril in hypertensive stroke patients: Results of the Japan Perindopril and Diuretics on Cerebrovascular Disease Study (J-PADOC).

Aims: An international randomized controlled trial has shown that anti-hypertensive therapy using perindopril and indapamide significantly reduces the recurrence of stroke. To evaluate the efficacy and safety of diuretics given as add-on therapy to stroke patients, as needed, to perindopril, we conducted a prospective multicenter observational study.

Methods: A total of 3825 hypertensive patients with a history of stroke were enrolled. The patients received a two-step therapy, starting with perindopril alone, and those who failed to achieve the blood pressure target were subsequently given a diuretic. Each group was followed for 6 months.

Results: 62.8% of the patients achieved the blood pressure goal. The incidence of adverse events was significantly higher in the perindopril plus diuretic combination therapy group than in the perindopril monotherapy group. Although these results may reflect that severely hypertensive patients were selectively assigned to combination therapy, the observed differences were essentially elevated serum creatinine, triglycerides, blood urea nitrogen and uric acid, whereas no significant inter-group difference was noted in total cholesterol and blood glucose.

Conclusions: If adequate care of compromised renal function is taken, perindopril plus diuretic combination therapy exerts potent hypotensive effects without posing significant safety problems in patients with a history of stroke.