Perindopril is a long-acting ACE inhibitor used in hypertension and stable coronary artery disease.

It has strong outcome data in vascular disease populations.

Class: → ACE Inhibitors

• Inhibits Angiotensin-Converting Enzyme (ACE) • ↓ Angiotensin II • ↓ Aldosterone • ↑ Bradykinin

Net Effects: • ↓ Systemic vascular resistance • ↓ Blood pressure • ↓ Ventricular remodeling • ↓ Vascular inflammation

Mechanism identical to other ACE inhibitors.

• Prodrug → converted to perindoprilat • Long-acting (once-daily dosing) • Strong evidence in stable coronary artery disease (EUROPA trial) • Stroke risk reduction data (PROGRESS trial)

More commonly used in Europe than the United States.

• Effective once-daily ACE inhibitor

→ Hypertension Module

• Reduces cardiovascular events (EUROPA trial) • Vascular protection in high-risk patients

• Reduced recurrent stroke risk (PROGRESS trial)

• Used similarly to other ACE inhibitors • Mortality benefit expected as class effect

→ Heart Failure Module

Hypertension: • Start: 4 mg once daily • Usual range: 4–8 mg once daily

Stable CAD: • Typically titrated to 8 mg daily (if tolerated)

Once-daily dosing.

• Prodrug → activated in liver • Renally cleared • Long half-life of active metabolite (~25–30 hours)

Dose adjustment required in renal impairment.

Class Effects: • Dry cough • Hyperkalemia • Hypotension • Angioedema (rare) • Mild creatinine elevation

No major pharmacologic difference from other ACE inhibitors.

Monitor: • Serum creatinine • Potassium

Check labs 1–2 weeks after initiation or dose adjustments.

• Pregnancy • History of ACE inhibitor–induced angioedema • Bilateral renal artery stenosis

✔ Long-acting ACE inhibitor ✔ Strong vascular protection data (EUROPA) ✔ Stroke reduction data (PROGRESS) ✔ More commonly used outside the U.S. ✔ Once-daily dosing

Related:

→ ACE Inhibitors → Ramipril → Heart Failure Module → Return to CV Modules