Perindopril

Perindopril is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension and heart failure. It is administered as a prodrug that is converted in the body to the active metabolite perindoprilat, which inhibits ACE and lowers the formation of angiotensin II while increasing bradykinin. This leads to vasodilation, reduced aldosterone secretion, and lower blood pressure.

Common indications include essential hypertension and symptomatic heart failure. In patients with stable coronary artery disease, low‑dose perindopril has been shown to reduce cardiovascular events in clinical trials such as EUROPA. The medication is also used as part of broader cardiovascular risk management in selected patients, under physician guidance.

Perindopril is given orally, usually once daily due to its long‑acting effects. Typical starting doses range from 2 to 4 mg daily, with gradual titration to 8–16 mg daily depending on response and tolerability. In heart failure, starting doses are similar, with gradual increases as tolerated. Dosing may be adjusted for renal impairment.

Common adverse effects include cough, dizziness, and hypotension. Hyperkalemia can occur, particularly with concurrent medications that raise potassium levels. Angioedema is a potential, though uncommon, risk. Contraindications include pregnancy, history of ACE‑inhibitor–associated angioedema, and bilateral renal artery stenosis. Caution is advised in kidney impairment and in patients taking potassium‑sparing diuretics or NSAIDs.

Brand names include Coversyl and Aceon in different markets. As with other ACE inhibitors, perindopril should be used during pregnancy only if clearly needed and clearly contraindicated in most cases.