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Perindopril did not reduce long-term mortality, morbidity in elderly people with diastolic HF
However, the ACE inhibitor helped improve NYHA class and six-minute walk distance and reduced hospitalization for HF at one year of follow-up.
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The Perindopril in Elderly People with Chronic Heart Failure study failed to show that perindopril could reduce long-term mortality or morbidity among elderly people with diastolic with heart failure.
The ACE inhibitor did, however, improve exercise capacity and NYHA functional class among the study cohort.
“PEP-CHF ran well for the first year but during the second year many patients came off assigned therapy and started open-label ACE inhibitors,” said John Cleland, MD, professor in the department of cardiology, University of Hull, United Kingdom, at the World Congress of Cardiology 2006. “Perindopril did improve symptoms of exercise capacity and reduced hospitalizations for heart failure, so perhaps despite the fact that this study did not produce a conclusive result on its primary endpoint there may be a role for perindopril in the management of this patient population.”
PEP-CHF results
PEP-CHF was designed to compare the effects of perindopril (Aceon, Solvay) and placebo on morbidity and mortality in older patients with clinical evidence of HF secondary to left ventricular diastolic dysfunction.
The 852 patients included in the multicenter (53 centers), randomized, parallel group, placebo-controlled study were older than 70 (median age 75, 25% older than 80), and mostly women, a first for a HF trial, Cleland said. For inclusion they had to be taking a diuretic for fluid congestion. Most patients had a history of hypertension.
The primary endpoint was a composite of mortality due to any cause and unplanned HF-related hospitalization with a minimum follow-up of one year. The median follow-up of patients was 26 months.
Initiation of perindopril was well tolerated. By one year, 65 patients (15.3%) assigned to placebo and 46 (10.8%) assigned to perindopril experienced a primary outcome event (P=.055). At the end of follow-up, there was no statistical significance between the two groups, but almost half of the patients stopped their study medication (placebo or perindopril 4 mg) after the one year follow-up, mostly to receive open-label ACE inhibitors.
During the first year, 53 (12.4%) patients assigned to the placebo and 34 (8%) receiving perindopril had an unplanned hospitalization for HF (P=.033). At one year, patients receiving active treatment were more likely to have an improved NYHA functional class (P<.03) and six-minute corridor walk distance (P=.02). – by Judith Rusk
For more information:
- Cleland J. The Perindopril in Elderly People With Chronic Heart Failure (PEP-CHF) study. Hot Line I. Presented at: World Congress of Cardiology 2006; Sept. 2-6, 2006; Barcelona.