Introduction
E-mail address: michal.tendera{at}gcm.pl
Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin-I to angiotensin-II, thus reducing the circulating and local levels of angiotensin-II. They can also inhibit kininase-II and increase bradykinin concentration. Their biological effects include a decrease in sympathetic activity and peripheral vascular resistance, improvement of endothelial function, and prevention of myocardial hypertrophy and fibrosis. Over the last decades, ACE inhibitors have had a central place in the treatment of cardiovascular disease. Hypertension, heart failure, and secondary prevention are the three most important therapeutic areas, where the role of ACE inhibitors is best established. Today, however, clinical benefits of ACE inhibitors are well documented along the entire continuum of the cardiovascular disease spectrum.1
Among the ACE inhibitors, perindopril is one of the best-studied drugs. Trials such as EUROPA,2 ASCOT-BPLA,3 PROGRESS,4 PEP-CHF,5 or PREAMI6 exemplify how the studies on perindopril have contributed to the improvement of our therapeutic armamentarium and to the understanding of the pathophysiology of cardiovascular disease.
This issue offers a comprehensive overview of the development of ACE inhibitors, in general, and perindopril, in particular.
Borer7 gives a historical perspective of the concept of ACE inhibition and describes how this drug class became a crucial component in the management of different cardiovascular conditions. He also offers a comparison between ACE inhibitors and other renin–angiotensin system inhibitors.
The paper by Fox8 gives a full review of clinical trials in which perindopril has been tested over the last 20 years, starting with its blood pressure lowering effect in patients with hypertension and finishing with clinical outcome data in patients with a wide spectrum of cardiovascular conditions.
Tardif and Talajic9 review evidence on the potential use of ACE inhibitors in the prevention of new-onset atrial fibrillation and recurrence of arrhythmia. They also present the design of the ongoing Canadian Trial of Atrial Fibrillation-2 (CTAF-2) that evaluates the role of perindopril in the prevention of atrial fibrillation recurrences in patients with hypertension.
Finally, Duboc et al.10 present their data on the effects of perindopril on left ventricular function and prognosis in patients with Duchenne muscular dystrophy. In this X-linked condition, progressive myocardial fibrosis resulting in the deterioration of left ventricular systolic function is responsible for death below the age of 30 years in 
40% of patients. The authors show that early initiation of treatment with perindopril may prevent or delay myocardial involvement, and generates a trend towards a lower mortality in this rare but fatal disease.
Conflict of interest: none declared.
3rd Division of Cardiology
Medical University of Silesia
Ziolowa 47
40-635 Katowice
Poland
References
- Lopez-Sendon J, Swedberg K, McMurray J, Tamargo J, Maggioni AP, Dargie H, Tendera M, Waagstein F, Kjekshus J, Lechat P, Torp-Pedersen C. Expert consensus document on angiotensin converting enzyme inhibitors in cardiovascular disease. Eur Heart J (2004) 25:1454–1470.
[Free Full Text] - Fox K. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet (2003) 362:782–788.[CrossRef][Web of Science][Medline]
- Dahlof B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M, Collins R, Kjeldsen SE, Kristinsson A, McInnes GT, Mehlsen J, Nieminen M, O'Brien E, Ostergren J. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial—Blood Pressure Lowering Arm (ASCOT-BPLA). Lancet (2005) 366:895–906. for the ASCOT investigators.[CrossRef][Web of Science][Medline]
- Berthet K, Neal BC, Chalmers JP, MacMahon SW, Bousser M.-G, Colman SA, Woodward M. Reduction in the risk of recurrent stroke in patients with and without diabetes: the PROGRESS trial. Blood Press (2004) 13:7–13.[CrossRef][Web of Science][Medline]
- Cleland JGF, Tendera M, Adamus J, Freemantle N, Polonski L, Taylor J, on behalf of the PEP-CHF investigators. The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J (2005) 26:1369–1378.
[Abstract/Free Full Text] - Ferrari R. Effects of angiotensin-converting enzyme inhibition with perindopril on left ventricular remodeling and clinical outcome: results of the randomized Perindopril and Remodeling in Elderly with Acute Myocardial Infarction (PREAMI) study. Arch Intern Med (2006) 166:659–666.
[Abstract/Free Full Text] - Borer JS. Angiotensin converting enzyme (ACE) inhibition: a landmark advance in treatment for cardiovascular disease. Eur Heart J Suppl (2007) 9:E2–E9.
[Abstract/Free Full Text] - Fox K. Contribution of perindopril to cardiology: 20 years of success. Eur Heart J Suppl (2007) 9:E10–E19.
[Abstract/Free Full Text] - Tardif JC, Talajic M. Perindopril and prevention of atrial fibrillation. Eur Heart J Suppl (2007) 9:E25–E29.
[Abstract/Free Full Text] - Duboc D, Meune C, Pierre B, et al. Perindopril preserves left ventricular function in X-linked Duchenne muscular dystrophy. Eur Heart J Suppl (2007) 9:E20–E24.
[Abstract/Free Full Text]
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