LAUSR

Previous studies showed that postmenopausal women are more likely to have poorly controlled hypertension than men of the same age. Whether this is caused by inadequate treatment or poor response to antihypertensive agents remains unknown. The aim of this study is to analyze treatment response to the most potent RAAS inhibitor perindopril in different age categories in women and men. Individual patient data was used from the combined EUROPA PROGRESS and ADVANCE trials which include patients with vascular disease (n=29463). We studied the relative and absolute changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) during a 4-week run-in phase in which all patients were treated with the perindopril-based treatment in different age categories. In total, 8366 women and 21097 men were included in the analysis. Women >65 years showed a significantly smaller blood pressure reduction after perindopril treatment (2.8 mmHg [95%CI 0.1-5.5] less reduction compared to women ≤45 years, P=0.039). In men, the SBP reduction after perindopril in patients >55-65 and >65 years was lower compared to the age category ≤45 years (adjusted mean difference >55-65: 2.8 mmHg [95% CI: 1.8-3.7], P<0.001, >65: 3.7 mmHg [95%CI: 2.7-4.7], P<0.001). A trend of less blood pressure reduction was seen with ageing in both men and women (P<0.001). To conclude, we observed that in both women and men the perindopril lead to less SBP reduction with increasing age while the DBP reduction increases with age. More research is needed to determine whether it would be beneficial to use age-adjusted perindopril dosages.