Which patients would benefit the most from the perindopril-amlodipine combination?

In the recent Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm trial, the amlodipine +/- perindopril strategy resulted in fewer deaths and cardiovascular events than an atenolol +/- thiazide strategy. Because of the intrinsic properties of both angiotensin-converting enzyme inhibitors, particularly in terms of secondary prevention of ischaemic heart disease, and calcium-channel blockers, in terms of anti-anginal properties, the combination of amlodipine and perindopril should prove particularly beneficial in patients with coronary artery disease and either hypertension or anginal symptoms. In addition, both classes of medications have a favourable metabolic profile and have been shown to reduce the occurrence of new-onset diabetes mellitus in a variety of clinical situations. Finally, the impact of the amlodipine +/- perindopril combination on central aortic pressure suggests a particular relevance in situations of increased central pulse pressure, such as elderly populations or patients with chronic kidney disease. Therefore, the amlodipine +/- perindopril combination is likely to offer important clinical benefits in a number of fairly common clinical conditions.