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    Clinical Trial Results:
    Efficacy and safety of fixed-dose combination Perindopril 5 mg / Indapamide 1.25 mg / Amlodipine 5 mg versus Perindopril 5 mg / Indapamide 1.25 mg single pill in patients with uncontrolled essential hypertension after 1 month of treatment by Perindopril 5 mg / Indapamide 1.25 mg single pill with conditional titration based on blood pressure control up to Perindopril 10 mg/ Indapamide 2.5 mg / Amlodipine 10 mg. An international, multicentre, randomised, double blind, 4-month superiority study.

    Summary
    EudraCT number
    2012-001658-24
    Trial protocol
    SK   CZ   HU   BG   PL  
    Global end of trial date
    28 Jul 2015

    Results information
    Results version number
    v1(current)
    This version publication date
    06 Aug 2016
    First version publication date
    06 Aug 2016
    Other versions

    Trial information

    Close Top of page
    Trial identification
    Sponsor protocol code
    CL3-06593-006
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Institut de recherches Internationale Servier
    Sponsor organisation address
    50 rue Carnot, Suresnes, France,
    Public contact
    Clinical Studies Department, Institut de Recherches Internationales Servier, 33 0155724366, clinicaltrials@servier.com
    Scientific contact
    Clinical Studies Department, Institut de Recherches Internationales Servier, 33 0155724366, clinicaltrials@servier.com
    Sponsor organisation name
    Les Laboratoires Servier Representative Office Paveletskaya
    Sponsor organisation address
    Paveletskaya square 2, building 3, Moscow, Russian Federation,
    Public contact
    Les Laboratoires Servier Representative Office Paveletskaya, Les Laboratoires Servier Representative Office Paveletskaya, +7 4959374767,
    Scientific contact
    Les Laboratoires Servier Representative Office Paveletskaya, Les Laboratoires Servier Representative Office Paveletskaya, +7 4959374767,
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    28 Jul 2015
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    28 Jul 2015
    Global end of trial reached?
    Yes
    Global end of trial date
    28 Jul 2015
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    ­To demonstrate the superiority effect of fixed-dose combination Perindopril / Indapamide / Amlodipine in single-pill versus bi-therapy in single pill in lowering office systolic blood pressure at the end of one month of treatment.
    Protection of trial subjects
    Controlled hypertension was defined according to the hypertension management guidelines (WHO/ISH, 2003; ESC, 2009) and was in accordance with the recent guideline of the task force for the management of arterial hypertension of the ESH and the ESC (2013) , as the blood pressure values were under the following targets: SBP < 140 mmHg and DBP < 90 mmHg. A run-in period of 1 month was dedicated to confirm the essential uncontrolled hypertension in patients under Perindopril 5 mg/Indapamide 1.25 mg single pill treatment. Study treatments should be prematurely and definitively discontinued for a participant for one of the following reasons: -Patients having at any visit whatever the dosage of study treatment used : SBP >= 180 mmHg and/or DBP >= 110 mmHg. -Patients who were up-titrated at any visit and had at the following visit SBP >= 160 mmHg or DBP >= 100 mmHg. - Patients having not controlled BP at the clinical visit M6; M9; M12 confirmed by the HBPM measurements performed by the patient at home: SBP >= 135 mmHg or DBP >= 85 mmHg (within 4 days before the clinical visit). - Onset of adverse event which presented a risk for the patient or made it unsafe for the patient to continue with the study treatment. Pregnancy. ­Major protocol deviation preventing the analysis of the main endpoint, or which, in the opinion of the investigator, made it unsafe for the patient to continue to take the study medication and to stay in the study. ­Non-medical reason (patient's decision personal).
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    22 Jan 2013
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Poland: 7
    Country: Number of subjects enrolled
    Slovakia: 18
    Country: Number of subjects enrolled
    Bulgaria: 35
    Country: Number of subjects enrolled
    Czech Republic: 7
    Country: Number of subjects enrolled
    Hungary: 20
    Country: Number of subjects enrolled
    Brazil: 3
    Country: Number of subjects enrolled
    Argentina: 61
    Country: Number of subjects enrolled
    Mexico: 18
    Country: Number of subjects enrolled
    Romania: 38
    Country: Number of subjects enrolled
    Russian Federation: 114
    Country: Number of subjects enrolled
    Singapore: 2
    Country: Number of subjects enrolled
    Ukraine: 116
    Country: Number of subjects enrolled
    Vietnam: 15
    Worldwide total number of subjects
    454
    EEA total number of subjects
    125
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    386
    From 65 to 84 years
    66
    85 years and over
    2

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    ­A 4 weeks open label run-in period from selection was dedicated to confirm the essential non-controlled hypertension on Perindopril 5 mg/Indapamide 1.25 mg. Only eligible patients having still an uncontrolled hypertension were randomised to IMPs.

    Period 1
    Period 1 title
    Double-blind treatment period (4 months)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst, Carer, Assessor

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Starting with Perindopril/Indapamide/Amlodipine
    Arm description
    The starting dose at inclusion was perindopril 5 mg/indapamide 1.25 mg/ Amlodipine 5 mg administered orally. Then, the patients could receive, depending on the blood pressure values an uptitration from M1 (not controlled BP defined as: SBP 140 >= mmHg or DBP>= 90 mmHg, and SBP < 180 mmHg and DBP < 110 mmHg): ­ Perindopril 5 mg/Indapamide 1.25 mg/Amlodipine 10 mg fixed dose combination. ­ Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 10 mg fixed dose combination.
    Arm type
    Experimental

    Investigational medicinal product name
    Perindopril/Indapamide/Amlodipine
    Investigational medicinal product code
    S06593
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    The study treatment was to be administered orally with water as one capsule daily in the morning before breakfast. The starting dose at inclusion was perindopril 5 mg/indapamide 1.25 mg/ Amlodipine 5 mg. Then, the patients with blood pressure not controlled (SBP >= 140 mmHg or DBP >= 90 mmHg, and SBP < 180 mmHg and DBP < 110 mmHg) could receive, depending on the blood pressure values an uptitration from M1: ­ Perindopril 5 mg/Indapamide 1.25 mg/Amlodipine 10 mg fixed dose combination. ­ Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 10 mg fixed dose combination. Of note, all patients received during the 1-month run-in period perindopril 5 mg/indapamide 1.25 mg.

    Arm title
    Starting with Perindopril/Indapamide
    Arm description
    Perindopril 5 mg / Indapamide 1.25 mg (as starting dose) fixed dose combination administered orally. Then, the patients could receive the test drug, depending on the blood pressure values an uptitration from M1 (not controlled BP defined as : SBP >= 140 mmHg or DBP >= 90 mmHg, and SBP < 180 mmHg and DBP < 110 mmHg). ­ Perindopril 5 mg/Indapamide 1.25 mg/Amlodipine 5 mg fixed dose combination. ­ Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 5 mg fixed dose combination. At M3, patients still uncontrolled with Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 5 mg could switch to Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 10 mg fixed dose combination.
    Arm type
    Active comparator

    Investigational medicinal product name
    Prindopril/Indapamide
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    Perindopril 5 mg / Indapamide 1.25 mg (as starting dose) fixed dose combination administered orally with water as one capsule daily in the morning before breakfast. Then, the patients with blood pressure not controlled (SBP >= 140 mmHg or DBP >= 90 mmHg, and SBP < 180 mmHg and DBP < 110 mmHg) could receive the test drug, depending on the blood pressure values an uptitration from M1: ­ Perindopril 5 mg/Indapamide 1.25 mg/Amlodipine 5 mg fixed dose combination. ­ Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 5 mg fixed dose combination. At M3, patients still uncontrolled with Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 5 mg could switch to Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 10 mg fixed dose combination. Of note, all patients received during the 1-month run-in period perindopril 5 mg/indapamide 1.25 mg.

    Number of subjects in period 1
    Starting with Perindopril/Indapamide/Amlodipine Starting with Perindopril/Indapamide
    Started
    227
    227
    Completed
    200
    197
    Not completed
    27
    30
         Adverse event, serious fatal
    1
    -
         Adverse event, non-fatal
    6
    2
         non-medical reasons
    9
    5
         patients not included
    -
    2
         Protocol deviation
    2
    5
         Other protocol withdrawal criteria
    9
    16
    Period 2
    Period 2 title
    Overall period M0-M15 including M4-M15
    Is this the baseline period?
    No
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst, Carer, Assessor

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Starting with Perindopril/Indapamide/Amlodipine M0-M15
    Arm description
    The starting dose at inclusion was perindopril 5 mg/indapamide 1.25 mg/ Amlodipine 5 mg administered orally. Then, the patients could receive, depending on the blood pressure values an uptitration from M1 (not controlled BP defined as: SBP 140 mmHg or DBP 90 mmHg, and SBP < 180 mmHg and DBP < 110 mmHg): ­ Perindopril 5 mg/Indapamide 1.25 mg/Amlodipine 10 mg fixed dose combination. ­ Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 10 mg fixed dose combination. From M4, all patients with BP controlled on Per10/Ind2.5/Aml5 or Per10/Ind2.5/Aml10 could enter in the extension period (M4-M15) and remained on this treatment dose.
    Arm type
    Experimental

    Investigational medicinal product name
    Perindopril/Indapamide/Amlodipine
    Investigational medicinal product code
    S06593
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    The study treatment was to be administered orally with water as one capsule daily in the morning before breakfast. The starting dose at inclusion was perindopril 5 mg/indapamide 1.25 mg/ Amlodipine 5 mg. Then, the patients with blood pressure not controlled (SBP >= 140 mmHg or DBP >= 90 mmHg, and SBP < 180 mmHg and DBP < 110 mmHg) could receive, depending on the blood pressure values an uptitration from M1: ­ Perindopril 5 mg/Indapamide 1.25 mg/Amlodipine 10 mg fixed dose combination. ­ Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 10 mg fixed dose combination. From M4, all patients with BP controlled on Per10/Ind2.5/Aml5 or Per10/Ind2.5/Aml10 could enter in the extension period (M4-M15) and remained on this treatment dose. Of note, all patients received during the 1-month run-in period perindopril 5 mg/indapamide 1.25 mg.

    Arm title
    Starting with Perindopril/Indapamide M0-M15
    Arm description
    Perindopril 5 mg / Indapamide 1.25 mg (as starting dose) fixed dose combination administered orally . Then, the patients could receive the test drug, depending on the blood pressure values an uptitration from M1 (not controlled BP defined as : SBP>= 140 mmHg or DBP >= 90 mmHg, and SBP < 180 mmHg and DBP < 110 mmHg). ­ Perindopril 5 mg/Indapamide 1.25 mg/Amlodipine 5 mg fixed dose combination. ­ Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 5 mg fixed dose combination. At M3, patients still uncontrolled with Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 5 mg could switch to Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 10 mg fixed dose combination.
    Arm type
    Active comparator

    Investigational medicinal product name
    Perindopril/Indapamide
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    Perindopril 5 mg / Indapamide 1.25 mg (as starting dose) fixed dose combination was administered orally with water as one capsule daily in the morning before breakfast. Then, the patients not controlled (SBP >= 140 mmHg or DBP >=90 mmHg, and SBP < 180 mmHg and DBP < 110 mmHg) could receive the test drug, depending on the blood pressure values an uptitration from M1: ­ Perindopril 5 mg/Indapamide 1.25 mg/Amlodipine 5 mg fixed dose combination. ­ Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 5 mg fixed dose combination. At M3, patients still uncontrolled with Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 5 mg could switch to Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 10 mg fixed dose combination. Of note, all patients received during the 1-month run-in period perindopril 5 mg/indapamide 1.25 mg.

    Number of subjects in period 2
    Starting with Perindopril/Indapamide/Amlodipine M0-M15 Starting with Perindopril/Indapamide M0-M15
    Started
    200
    197
    Completed
    40
    54
    Not completed
    160
    143
         Adverse event, serious fatal
    1
    -
         patients completed M0-M4 and not entering M4-M15
    159
    143

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Starting with Perindopril/Indapamide/Amlodipine
    Reporting group description
    The starting dose at inclusion was perindopril 5 mg/indapamide 1.25 mg/ Amlodipine 5 mg administered orally. Then, the patients could receive, depending on the blood pressure values an uptitration from M1 (not controlled BP defined as: SBP 140 >= mmHg or DBP>= 90 mmHg, and SBP < 180 mmHg and DBP < 110 mmHg): ­ Perindopril 5 mg/Indapamide 1.25 mg/Amlodipine 10 mg fixed dose combination. ­ Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 10 mg fixed dose combination.

    Reporting group title
    Starting with Perindopril/Indapamide
    Reporting group description
    Perindopril 5 mg / Indapamide 1.25 mg (as starting dose) fixed dose combination administered orally. Then, the patients could receive the test drug, depending on the blood pressure values an uptitration from M1 (not controlled BP defined as : SBP >= 140 mmHg or DBP >= 90 mmHg, and SBP < 180 mmHg and DBP < 110 mmHg). ­ Perindopril 5 mg/Indapamide 1.25 mg/Amlodipine 5 mg fixed dose combination. ­ Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 5 mg fixed dose combination. At M3, patients still uncontrolled with Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 5 mg could switch to Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 10 mg fixed dose combination.

    Reporting group values
    Starting with Perindopril/Indapamide/Amlodipine Starting with Perindopril/Indapamide Total
    Number of subjects
    227 227 454
    Age categorical
    Units: Subjects
        In utero
    0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0
        Newborns (0-27 days)
    0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0
        Children (2-11 years)
    0 0 0
        Adolescents (12-17 years)
    0 0 0
        Adults (18-64 years)
    194 192 386
        From 65-84 years
    32 34 66
        85 years and over
    1 1 2
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    54.5 ± 9.8 54.9 ± 9.9 -
    Gender categorical
    Units: Subjects
        Female
    88 113 201
        Male
    139 114 253
    Subject analysis sets

    Subject analysis set title
    Full Analysis Set (main office study)
    Subject analysis set type
    Full analysis
    Subject analysis set description
    Based on the the intention-to-treat principle, this set corresponded to all randomised patients who received at least one dose of study treatment and who had at least one analysable baseline value and one analysable post-baseline value at M1 for Systolic Blood Pressure (SBP).

    Subject analysis set title
    FAS-ABPM
    Subject analysis set type
    Full analysis
    Subject analysis set description
    Based on the intention-to-treat principle, the FAS-ABPM (ambulatory blood pressure monitoring) was defined as : all patients of Randomised Set ABPM* who received at least one dose of study treatment and who have at least one valid ABPM at baseline and one valid post-baseline ABPM for mean 24h systolic blood pressure at M1. The ABPM was a sub-study of the main study. * Randomised Set ABPM defined as a randomised patients in the main study who had performed at least one ABPM measurement.

    Subject analysis set title
    FAS-HBPM
    Subject analysis set type
    Full analysis
    Subject analysis set description
    Based on the intention-to-treat principle, the FAS-HBPM (Home Blood Pressure Monitoring) was defined as : all patients of RS-HBPM* who received at least one dose of study treatment and who had at least one valid HBPM at baseline and one valid post-baseline HBPM for mean HSBP over the 4 days preceding the study visit at M1. * defined as all randomised patients in the main study who had performed at least one HBPM measurement.

    Subject analysis sets values
    Full Analysis Set (main office study) FAS-ABPM FAS-HBPM
    Number of subjects
    449
    276
    263
    Age categorical
    Units: Subjects
        In utero
    0
    0
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
    0
    0
        Newborns (0-27 days)
    0
    0
    0
        Infants and toddlers (28 days-23 months)
    0
    0
    0
        Children (2-11 years)
    0
    0
    0
        Adolescents (12-17 years)
    0
    0
    0
        Adults (18-64 years)
    382
    236
    226
        From 65-84 years
    65
    39
    36
        85 years and over
    2
    1
    1
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    54.7 ± 9.8
    55.1 ± 9
    54.6 ± 9.6
    Gender categorical
    Units: Subjects
        Female
    198
    112
    121
        Male
    251
    164
    142

    End points

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    End points reporting groups
    Reporting group title
    Starting with Perindopril/Indapamide/Amlodipine
    Reporting group description
    The starting dose at inclusion was perindopril 5 mg/indapamide 1.25 mg/ Amlodipine 5 mg administered orally. Then, the patients could receive, depending on the blood pressure values an uptitration from M1 (not controlled BP defined as: SBP 140 >= mmHg or DBP>= 90 mmHg, and SBP < 180 mmHg and DBP < 110 mmHg): ­ Perindopril 5 mg/Indapamide 1.25 mg/Amlodipine 10 mg fixed dose combination. ­ Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 10 mg fixed dose combination.

    Reporting group title
    Starting with Perindopril/Indapamide
    Reporting group description
    Perindopril 5 mg / Indapamide 1.25 mg (as starting dose) fixed dose combination administered orally. Then, the patients could receive the test drug, depending on the blood pressure values an uptitration from M1 (not controlled BP defined as : SBP >= 140 mmHg or DBP >= 90 mmHg, and SBP < 180 mmHg and DBP < 110 mmHg). ­ Perindopril 5 mg/Indapamide 1.25 mg/Amlodipine 5 mg fixed dose combination. ­ Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 5 mg fixed dose combination. At M3, patients still uncontrolled with Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 5 mg could switch to Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 10 mg fixed dose combination.
    Reporting group title
    Starting with Perindopril/Indapamide/Amlodipine M0-M15
    Reporting group description
    The starting dose at inclusion was perindopril 5 mg/indapamide 1.25 mg/ Amlodipine 5 mg administered orally. Then, the patients could receive, depending on the blood pressure values an uptitration from M1 (not controlled BP defined as: SBP 140 mmHg or DBP 90 mmHg, and SBP < 180 mmHg and DBP < 110 mmHg): ­ Perindopril 5 mg/Indapamide 1.25 mg/Amlodipine 10 mg fixed dose combination. ­ Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 10 mg fixed dose combination. From M4, all patients with BP controlled on Per10/Ind2.5/Aml5 or Per10/Ind2.5/Aml10 could enter in the extension period (M4-M15) and remained on this treatment dose.

    Reporting group title
    Starting with Perindopril/Indapamide M0-M15
    Reporting group description
    Perindopril 5 mg / Indapamide 1.25 mg (as starting dose) fixed dose combination administered orally . Then, the patients could receive the test drug, depending on the blood pressure values an uptitration from M1 (not controlled BP defined as : SBP>= 140 mmHg or DBP >= 90 mmHg, and SBP < 180 mmHg and DBP < 110 mmHg). ­ Perindopril 5 mg/Indapamide 1.25 mg/Amlodipine 5 mg fixed dose combination. ­ Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 5 mg fixed dose combination. At M3, patients still uncontrolled with Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 5 mg could switch to Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 10 mg fixed dose combination.

    Subject analysis set title
    Full Analysis Set (main office study)
    Subject analysis set type
    Full analysis
    Subject analysis set description
    Based on the the intention-to-treat principle, this set corresponded to all randomised patients who received at least one dose of study treatment and who had at least one analysable baseline value and one analysable post-baseline value at M1 for Systolic Blood Pressure (SBP).

    Subject analysis set title
    FAS-ABPM
    Subject analysis set type
    Full analysis
    Subject analysis set description
    Based on the intention-to-treat principle, the FAS-ABPM (ambulatory blood pressure monitoring) was defined as : all patients of Randomised Set ABPM* who received at least one dose of study treatment and who have at least one valid ABPM at baseline and one valid post-baseline ABPM for mean 24h systolic blood pressure at M1. The ABPM was a sub-study of the main study. * Randomised Set ABPM defined as a randomised patients in the main study who had performed at least one ABPM measurement.

    Subject analysis set title
    FAS-HBPM
    Subject analysis set type
    Full analysis
    Subject analysis set description
    Based on the intention-to-treat principle, the FAS-HBPM (Home Blood Pressure Monitoring) was defined as : all patients of RS-HBPM* who received at least one dose of study treatment and who had at least one valid HBPM at baseline and one valid post-baseline HBPM for mean HSBP over the 4 days preceding the study visit at M1. * defined as all randomised patients in the main study who had performed at least one HBPM measurement.

    Primary: Office supine systolic blood pressure at M1 visit

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    End point title
    Office supine systolic blood pressure at M1 visit
    End point description
    To study the effect of fixed-dose combination P5/I1.25/A5 in single-pill versus P5/I1.25 in single pill in lowering office SBP at the end of one month of treatment, a between group comparison was performed on the change of supine SBP from baseline to M1 post-baseline value, using an analysis of covariance (ANCOVA) model.
    End point type
    Primary
    End point timeframe
    The change in office supine systolic blood pressure was calculated between baseline and M1
    End point values
    Starting with Perindopril/Indapamide/Amlodipine Starting with Perindopril/Indapamide
    Number of subjects analysed
    225
    224
    Units: mmHg
        arithmetic mean (standard deviation)
    -19.18 ± 14.5
    -17.29 ± 16.4
    Statistical analysis title
    Change in office systolic blood pressure M0-M1
    Statistical analysis description
    To study the superiority effect of fixed-dose combination P5/I1.25/A5 in single-pill versus P5/I1.25 in single pill in lowering office SBP over M0-M1, a between group comparison was performed in the FAS on the change of supine SBP from baseline to M1 post-baseline value, using an analysis of covariance (ANCOVA) model. This analysis included the fixed, categorical effect of treatment and the fixed categorical effect of country as well as the continuous, fixed covariate of baseline.
    Comparison groups
    Starting with Perindopril/Indapamide/Amlodipine v Starting with Perindopril/Indapamide
    Number of subjects included in analysis
    449
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.05
    Method
    ANCOVA
    Parameter type
    Mean difference (final values)
    Point estimate
    -2.56
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -5.16
         upper limit
    0.04
    Variability estimate
    Standard error of the mean
    Dispersion value
    1.32
    Statistical analysis title
    Change over M0-M1 including adjustment on gender
    Statistical analysis description
    At study entry, the relevant imbalance between-groups in the gender distribution that is likely due to chance, with a greater proportion of women in the starting Per/Ind group as compared to the starting Per/Ind/Aml group, justifying to perform a post-hoc sensitivity analysis adjusted on gender. The same model as the main analysis (ANCOVA adjusted on treatment, baseline and country), additionally adjusted on gender, was used.
    Comparison groups
    Starting with Perindopril/Indapamide/Amlodipine v Starting with Perindopril/Indapamide
    Number of subjects included in analysis
    449
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    = 0.02
    Method
    ANCOVA
    Parameter type
    Mean difference (final values)
    Point estimate
    -3.05
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -5.63
         upper limit
    -0.46
    Variability estimate
    Standard error of the mean
    Dispersion value
    1.32
    Statistical analysis title
    Change over M0-M1/sustained hypertension/FAS-ABPM
    Statistical analysis description
    The between-group comparison of the office SBP in patients with sustained hypertension (uncontrolled hypertension confirmed at both office and 24-hour ABPM [mean 24h ASBP ≥ 130 mmHg or mean 24h ADBP ≥ 80 mmHg]) was performed on the change from baseline to last post-baseline value at M1 using an analysis of covariance (ANCOVA) adjusted on treatment, baseline, country (fixed effects), in the FAS-ABPM.
    Comparison groups
    Starting with Perindopril/Indapamide/Amlodipine v Starting with Perindopril/Indapamide
    Number of subjects included in analysis
    449
    Analysis specification
    Post-hoc
    Analysis type
    superiority [1]
    P-value
    = 0.02
    Method
    ANCOVA
    Parameter type
    Mean difference (final values)
    Point estimate
    -4.12
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -7.52
         upper limit
    -0.72
    Variability estimate
    Standard error of the mean
    Dispersion value
    1.73
    Notes
    [1] - This analysis was performed in the FAS-ABPM (N = 276)
    Statistical analysis title
    Change M0-M1/sustained hypertension/gender adj.
    Statistical analysis description
    The between-group comparison of the office SBP in patients with sustained hypertension (uncontrolled hypertension confirmed at both office and 24-hour ABPM [mean 24h ASBP ≥ 130 mmHg or mean 24h ADBP ≥ 80 mmHg]) was performed on the change from baseline to last post-baseline value at M1 using an analysis of covariance (ANCOVA) adjusted on treatment, baseline, country (fixed effects),and gender in the FAS-ABPM.
    Comparison groups
    Starting with Perindopril/Indapamide/Amlodipine v Starting with Perindopril/Indapamide
    Number of subjects included in analysis
    449
    Analysis specification
    Post-hoc
    Analysis type
    superiority [2]
    P-value
    = 0.002
    Method
    ANCOVA
    Parameter type
    Mean difference (final values)
    Point estimate
    -5.29
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -8.62
         upper limit
    -1.96
    Variability estimate
    Standard error of the mean
    Dispersion value
    1.69
    Notes
    [2] - This analysis was performed in the FAS-ABPM (N = 276)

    Primary: 24H Ambulatory Systolic Blood Pressure over M0-M1 (ABPM sub-study)

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    End point title
    24H Ambulatory Systolic Blood Pressure over M0-M1 (ABPM sub-study)
    End point description
    The 24h Ambulatory Systolic Blood Pressure (ASBP) was the main endpoint of the Ambulatory Blood pressure Monitoring (ABPM) sub-study. The change over M0-M1 was provided in the FAS-ABPM.
    End point type
    Primary
    End point timeframe
    M0-M1
    End point values
    Starting with Perindopril/Indapamide/Amlodipine Starting with Perindopril/Indapamide
    Number of subjects analysed
    134
    142
    Units: mmHg
        arithmetic mean (standard deviation)
    -8.73 ± 13.03
    -4.86 ± 12.93
    Statistical analysis title
    24h ASBP change over M0-M1
    Statistical analysis description
    To demonstrate efficacy of P5/I1.25/A5 as compared to P5/I1.25 at M1 in measurement of mean 24h Ambulatory Systolic Blood Pressure (ASBP) measured after 24h continuous SBP measures, a between group comparison was performed in the FAS-ABPM on the change from baseline to M1 post-baseline value, using an analysis of covariance (ANCOVA) model. This analysis included the fixed, categorical effect of treatment and the continuous, fixed covariate of baseline.
    Comparison groups
    Starting with Perindopril/Indapamide/Amlodipine v Starting with Perindopril/Indapamide
    Number of subjects included in analysis
    276
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.006
    Method
    ANCOVA
    Parameter type
    Mean difference (final values)
    Point estimate
    -3.74
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -6.39
         upper limit
    -1.09
    Variability estimate
    Standard error of the mean
    Dispersion value
    1.35

    Primary: Home systolic blood pressure global over M0-M1 (HBPM sub-study)

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    End point title
    Home systolic blood pressure global over M0-M1 (HBPM sub-study)
    End point description
    The Home systolic blood pressure (HSBP) global (i.e. morning and evening, mean of the 4 days preceding the visit) was the main endpoint of the Home Blood Pressure Monitoring (HBPM) sub-study. The change over M0-M1 was provided in the FAS-HBPM.
    End point type
    Primary
    End point timeframe
    M0-M1
    End point values
    Starting with Perindopril/Indapamide/Amlodipine Starting with Perindopril/Indapamide
    Number of subjects analysed
    135
    128
    Units: mmHg
        arithmetic mean (standard deviation)
    -10.28 ± 12.69
    -4.95 ± 14.01
    Statistical analysis title
    HSBP change over M0-M1
    Statistical analysis description
    To demonstrate efficacy of P5/I1.25/A5 as compared to P5/I1.25 at M1 in measurement of Home Systolic Blood pressure HSBP (morning and evening, means 4 days preceding the visit), a between group comparison was performed in the FAS-HBPM on the change from baseline to M1 post-baseline value, using an analysis of covariance (ANCOVA) model. This analysis included the fixed, categorical effect of treatment and the continuous,fixed covariate of baseline.
    Comparison groups
    Starting with Perindopril/Indapamide/Amlodipine v Starting with Perindopril/Indapamide
    Number of subjects included in analysis
    263
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.001
    Method
    ANCOVA
    Parameter type
    Mean difference (final values)
    Point estimate
    -4.62
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -7.36
         upper limit
    -1.89
    Variability estimate
    Standard error of the mean
    Dispersion value
    1.39

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Double-blind 1 month period (M0-M1) for each group and overall period M0-M15 including extension M4-M15 for overall patients
    Adverse event reporting additional description
    Emergent adverse events are presented (EAE) . EAE on treatment on the whole study (overall, M0-M15) were defined as all adverse events which occurred between the first study drug intake date (included) and the last study drug intake date + 7 days (included), or which worsened or became serious.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    17.0
    Reporting groups
    Reporting group title
    Starting with Per/Ind/Aml [M0-M1]
    Reporting group description
    The study treatment was to be administered orally with water as one capsule daily. The starting dose at inclusion was perindopril 5 mg/indapamide 1.25 mg/ Amlodipine 5 mg. Then, the patients could receive, depending on the blood pressure titration from M1: ­ - Perindopril 5 mg/Indapamide 1.25 mg/Amlodipine 10 mg fixed dose combination. ­ - Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 10 mg fixed dose combination. Of note, all patients received during the 1-month run-in period perindopril 5 mg/indapamide 1.25 mg.

    Reporting group title
    Starting with Per/Ind [M0-M1]
    Reporting group description
    Perindopril 5 mg / Indapamide 1.25 mg (as starting dose) fixed dose combination administered orally with water as one capsule daily. Then, the patients could receive the test drug, depending on the blood pressure titration from M1: ­ - Perindopril 5 mg/Indapamide 1.25 mg/Amlodipine 5 mg fixe dose combination. ­ - Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 5 mg fixed dose combination. At M3, patients still uncontrolled with Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 5 mg could switch to Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 10 mg fixed dose combination.

    Reporting group title
    All patients [M0-M15]
    Reporting group description
    This group includes all patients included in the study and that entered or not in the M4-M15 period, whatever the Perindopril/Indapamide/Amlodipine or Perindopril/Indapamide starting group.

    Serious adverse events
    Starting with Per/Ind/Aml [M0-M1] Starting with Per/Ind [M0-M1] All patients [M0-M15]
    Total subjects affected by serious adverse events
         subjects affected / exposed
    7 / 227 (3.08%)
    1 / 225 (0.44%)
    9 / 452 (1.99%)
         number of deaths (all causes)
    0
    0
    2
         number of deaths resulting from adverse events
    0
    0
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Chronic myeloid leukaemia
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Meningioma benign
         subjects affected / exposed
    0 / 227 (0.00%)
    1 / 225 (0.44%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Nerve root injury cervical
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Tendon rupture
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac disorders
    Angina pectoris
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Angina unstable
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Myocarditis
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Supraventricular tachycardia
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Surgical and medical procedures
    Intraocular lens implant
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Nervous system disorders
    Chronic inflammatory demyelinating polyradiculoneuropathy
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Grand mal convulsion
         subjects affected / exposed
    0 / 227 (0.00%)
    1 / 225 (0.44%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ischaemic cerebral infarction
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Splenic infarction
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Sudden death
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Ascites
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pleurisy
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pulmonary fibrosis
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Psychiatric disorders
    Depression
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal and urinary disorders
    Renal infarct
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Endocarditis bacterial
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Staphylococcal sepsis
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Starting with Per/Ind/Aml [M0-M1] Starting with Per/Ind [M0-M1] All patients [M0-M15]
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    54 / 227 (23.79%)
    49 / 225 (21.78%)
    111 / 452 (24.56%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Brain neoplasm
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Pancreatic neoplasm
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Prostatic adenoma
         subjects affected / exposed
    0 / 227 (0.00%)
    1 / 225 (0.44%)
    1 / 452 (0.22%)
         occurrences all number
    0
    1
    1
    Vascular disorders
    Aortic arteriosclerosis
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    1
    0
    1
    Arteriosclerosis
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    1
    0
    1
    Hypertension
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    2 / 452 (0.44%)
         occurrences all number
    1
    0
    2
    Hypotension
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    4 / 452 (0.88%)
         occurrences all number
    0
    0
    4
    Orthostatic hypotension
         subjects affected / exposed
    2 / 227 (0.88%)
    0 / 225 (0.00%)
    3 / 452 (0.66%)
         occurrences all number
    2
    0
    3
    Surgical and medical procedures
    Continuous positive airway pressure
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    1
    0
    1
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Fatigue
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Oedema peripheral
         subjects affected / exposed
    4 / 227 (1.76%)
    0 / 225 (0.00%)
    6 / 452 (1.33%)
         occurrences all number
    4
    0
    6
    Reproductive system and breast disorders
    Erectile dysfunction
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    1
    0
    1
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    2 / 227 (0.88%)
    1 / 225 (0.44%)
    6 / 452 (1.33%)
         occurrences all number
    2
    1
    6
    Emphysema
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    1
    0
    1
    Nasal septum deviation
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    1
    0
    1
    Psychiatric disorders
    Terminal insomnia
         subjects affected / exposed
    0 / 227 (0.00%)
    1 / 225 (0.44%)
    1 / 452 (0.22%)
         occurrences all number
    0
    1
    1
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    2 / 452 (0.44%)
         occurrences all number
    0
    0
    2
    Aspartate aminotransferase increased
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Blood creatinine increased
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Blood glucose increased
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Blood urea increased
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Blood uric acid increased
         subjects affected / exposed
    0 / 227 (0.00%)
    1 / 225 (0.44%)
    8 / 452 (1.77%)
         occurrences all number
    0
    1
    8
    Body temperature increased
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Creatinine renal clearance decreased
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Gamma-glutamyltransferase increased
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    3 / 452 (0.66%)
         occurrences all number
    0
    0
    3
    Glomerular filtration rate decreased
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Injury, poisoning and procedural complications
    Accidental overdose
         subjects affected / exposed
    0 / 227 (0.00%)
    1 / 225 (0.44%)
    3 / 452 (0.66%)
         occurrences all number
    0
    1
    3
    Foot fracture
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Laceration
         subjects affected / exposed
    0 / 227 (0.00%)
    1 / 225 (0.44%)
    1 / 452 (0.22%)
         occurrences all number
    0
    1
    1
    Spinal compression fracture
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Cardiac disorders
    Aortic valve calcification
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    1
    0
    1
    Aortic valve incompetence
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    1
    0
    1
    Bradycardia
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Sinus bradycardia
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Supraventricular extrasystoles
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    1
    0
    1
    Tricuspid valve incompetence
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    1
    0
    1
    Nervous system disorders
    Acoustic neuritis
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    1
    0
    2
    Cerebral ischaemia
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Dizziness
         subjects affected / exposed
    1 / 227 (0.44%)
    2 / 225 (0.89%)
    4 / 452 (0.88%)
         occurrences all number
    1
    2
    5
    Dysgeusia
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Headache
         subjects affected / exposed
    2 / 227 (0.88%)
    3 / 225 (1.33%)
    7 / 452 (1.55%)
         occurrences all number
    2
    3
    7
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Eye disorders
    Vision blurred
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Gastrointestinal disorders
    Constipation
         subjects affected / exposed
    0 / 227 (0.00%)
    1 / 225 (0.44%)
    1 / 452 (0.22%)
         occurrences all number
    0
    1
    1
    Diarrhoea
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    2 / 452 (0.44%)
         occurrences all number
    0
    0
    2
    Duodenitis
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    2 / 452 (0.44%)
         occurrences all number
    1
    0
    2
    Duodenogastric reflux
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Dyspepsia
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Food poisoning
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    3 / 452 (0.66%)
         occurrences all number
    0
    0
    3
    Gastritis
         subjects affected / exposed
    1 / 227 (0.44%)
    1 / 225 (0.44%)
    2 / 452 (0.44%)
         occurrences all number
    1
    1
    2
    Gastrooesophageal reflux disease
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Gingival hypertrophy
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Hiatus hernia
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    1
    0
    1
    Pancreatolithiasis
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Toothache
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    2 / 452 (0.44%)
         occurrences all number
    0
    0
    2
    Skin and subcutaneous tissue disorders
    Petechiae
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Pruritus generalised
         subjects affected / exposed
    0 / 227 (0.00%)
    1 / 225 (0.44%)
    1 / 452 (0.22%)
         occurrences all number
    0
    1
    1
    Renal and urinary disorders
    Renal cyst
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Back pain
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    2 / 452 (0.44%)
         occurrences all number
    1
    0
    2
    Intervertebral disc protrusion
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Muscle spasms
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Spinal osteoarthritis
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Spinal pain
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Infections and infestations
    Acute tonsillitis
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Bronchitis
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    4 / 452 (0.88%)
         occurrences all number
    1
    0
    4
    Cystitis
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Gastroenteritis
         subjects affected / exposed
    0 / 227 (0.00%)
    1 / 225 (0.44%)
    2 / 452 (0.44%)
         occurrences all number
    0
    1
    2
    Nasopharyngitis
         subjects affected / exposed
    0 / 227 (0.00%)
    1 / 225 (0.44%)
    6 / 452 (1.33%)
         occurrences all number
    0
    1
    6
    Pharyngitis
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Pulpitis dental
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Pyelonephritis chronic
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    1
    0
    1
    Respiratory tract infection
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Rhinitis
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    3 / 452 (0.66%)
         occurrences all number
    1
    0
    3
    Upper respiratory tract infection
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Viral upper respiratory tract infection
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    1
    0
    1
    Metabolism and nutrition disorders
    Hypercholesterolaemia
         subjects affected / exposed
    1 / 227 (0.44%)
    1 / 225 (0.44%)
    5 / 452 (1.11%)
         occurrences all number
    1
    1
    5
    Hyperglycaemia
         subjects affected / exposed
    0 / 227 (0.00%)
    1 / 225 (0.44%)
    5 / 452 (1.11%)
         occurrences all number
    0
    1
    5
    Hyperkalaemia
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    1 / 452 (0.22%)
         occurrences all number
    0
    0
    1
    Hypertriglyceridaemia
         subjects affected / exposed
    0 / 227 (0.00%)
    0 / 225 (0.00%)
    5 / 452 (1.11%)
         occurrences all number
    0
    0
    5
    Hyperuricaemia
         subjects affected / exposed
    0 / 227 (0.00%)
    2 / 225 (0.89%)
    14 / 452 (3.10%)
         occurrences all number
    0
    2
    14
    Hypokalaemia
         subjects affected / exposed
    0 / 227 (0.00%)
    2 / 225 (0.89%)
    11 / 452 (2.43%)
         occurrences all number
    0
    2
    12
    Type 2 diabetes mellitus
         subjects affected / exposed
    1 / 227 (0.44%)
    0 / 225 (0.00%)
    3 / 452 (0.66%)
         occurrences all number
    1
    0
    3

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    18 Dec 2012
    This amendement was was applicable in all countries involved in the study. The main changes followed the coordinators’ opinion, and concerned mainly the modification of some selection / inclusion criteria.
    16 Jan 2013
    This amendement was only applicable in Argentina, to comply with local regulation. A urinary pregnancy test was included at study entrance and then regularly, i.e. at all visits. Results had to be known before any dispensation of the study medication.
    01 Jul 2013
    This amendement was applicable in all countries involved in the study. The main changes were: ­ For registration purpose, a 11-month double-blind follow-up extension period was added in order to collect 1 year safety data of a minimum of 100 patients treated with the highest doses of fixed-dose combination (Perindopril 10 mg / Indapamide 2.5 mg / Amlodipine 10 mg), and to confirm the sustained efficacy of this treatment over one year. Thus, a 4 month double-blind superiority study followed by a double-blind follow-up extension period until M15 were implemented instead of the 12-weeks double-blind period initially planned in the study protocol. The title, the objectives, and the design of the study were accordingly modified. ­ The design was adapted to keep the investigators and the Sponsor blinded with regard to the treatment group allocated to the patients over the efficacy / safety 4-month titration period and its follow-up extension. ­ - For safety reasons and to have a better follow-up of the patients over the 11-month extension period, HBPM measurements had been added for all patients in the study, and performed at M4 and M15. Moreover, for the patients who took part to the extension period, even if not involved in the sub-studies during the titration period, the ABPM was to be performed only at M15 during the week before the last visit with the objective to obtain the 24 hours profile. ­ - In order to detect possible differences between right and left arms, at the request of the investigators, it was decided to simplify the definition of the dominant arm for the BP measurement. At the first visit, the investigator was asked to take only 1 measurement of SBP and DBP (instead of 3) in supine position in both right and left arms. ­ - The 2013 ESH/ECS guidelines for management of arterial hypertension were implemented.
    04 Feb 2014
    This amendement was only applicable in Ukraine in order to: postpone the Last Visit Last Patient (LVLP) date due to the extension of the recruitment period In accordance with the most recent quality information submitted to authorities, the storage conditions for the Therapeutic Units to be used in the study were included in this protocol version. No special storage was any more required. ­There was a discrepancy regarding the measurement time of the complete laboratory test at selection visit (ASSE). It had been harmonized throughout the protocol to become: “the complete laboratory test at ASSE visit will be performed during the week after selection and preferably between day 5 to 7”. This precision was given in order to obtain the laboratory results around one week after starting the run-in treatment period and to allow a better monitoring of the biological parameters to detect possible modifications induced by the treatment (Perindopril 5 mg / Indapamide 1.25 mg).
    04 Jun 2014
    This amendement was applicable in all country involved in the study. The purpose of this amendment was to remove the extension period that was added following Amendment No. 3. Indeed, in the countries where the registration was foreseen, the Health Authorities did not require 1 year safety data collection with the highest dose of this combination to reach a Marketing Authorisation. Consequently, the benefit/risk ratio of the study drug being sufficient at the time of the study, the extension part was no more justified. The study title, the study objectives, and the study design were accordingly modified. All patients had to perform the final M4 visit except patients who were already on going in the extension part of the study. For patients already ongoing in the extension period, the study was to be stopped at the next visit planned in the previously approved protocol (M6, M9, M12 or M15). At this final visit, patients were to perform all examinations requested for the withdrawal, including complete laboratory tests, weight and ECG. However, if the consent of the Amendment No. 6 was not obtained, patients were to stop the study at the visit (M6, M9, M12 or M15 visit) and to perform only assessment scheduled at the visit in accordance with the current signed ICF. The other patients who were not yet entered in the extension period were to perform the final visit at M4.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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