ATC Group: C09BX ACE inhibitors, other combinations

Perindopril is an inhibitor of the enzyme that converts angiotensin I into angiotensin II (ACE). Inhibition of ACE results in a reduction of angiotensin II in the plasma, which leads to increased plasma renin activity and reduced secretion of aldosterone. Since ACE inactivates bradykinin, inhibition of ACE also results in an increased activity of circulating and local kallikrein-kinin systems. It is possible that this mechanism contributes to the blood pressure-lowering action of ACE inhibitors. Bisoprolol is a highly beta1-selective-adrenoceptor blocking agent, lacking intrinsic stimulating and relevant membrane stabilising activity. Bisoprolol is generally not to be expected to influence the airway resistance and beta2-mediated metabolic effects.

Combination of three antihypertensive components with complementary mechanisms to control blood pressure in patient with hypertension. Perindopril is an angiotensin converting enzyme inhibitor, indapamide, a chlorosulphamoyl diuretic and amlodipine, a calcium ion flux inhibitor of the dihydropyridine group.

Ramiprilat, the active metabolite of the prodrug ramipril, inhibits the enzyme dipeptidylcarboxypeptidase I. Decreased formation of angiotensin II and inhibition of bradykinin degradation lead to vasodilation. Amlodipine is a calcium ion influx inhibitor of the dihydropyridine group and inhibits the entry of calcium ions through the cell membrane into cardiac cells and smooth muscle fibers. Hydrochlorothiazide is a thiazide diuretic. The mechanism of antihypertensive action of thiazide diuretics is not fully understood.