Reflex Supraventricular Tachycardia and Chest Pain Following the First Dose of Fixed-Dose Perindopril/Amlodipine in an Older Patient with Hypertension and Type 2 Diabetes Mellitus: A Case Report

Background

Fixed-dose combinations (FDCs) of an angiotensin-converting enzyme (ACE) inhibitor and a dihydropyridine calcium-channel blocker (CCB) are recommended as initial therapy for most patients with arterial hypertension and are generally well tolerated. Reflex tachycardia has not previously been reported with the perindopril/amlodipine combination. Case Presentation: A 70-year-old Caucasian man with arterial hypertension and type 2 diabetes mellitus developed chest pain 1 hour after the first dose of AlmirinComb 4/5 mg (perindopril 4 mg/amlodipine 5 mg). The prehospital ECG showed supraventricular tachycardia (SVT), which was terminated with adenosine (6 mg, then 12 mg); conversion to sinus rhythm was accompanied by transient inferior ST denivelation, and the chest pain resolved immediately. On arrival at the hospital, he was pain-free, haemodynamically stable (blood pressure 162/90 mmHg, heart rate 82 beats/min), and in normal sinus rhythm without ST-segment changes; serial high-sensitivity troponin I values remained within the normal range. Cardiology consultation attributed the event to reflex tachycardia. According to the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) causality assessment system, the reaction was classified as probable. He was discharged on nebivolol with scheduled ambulatory follow-up (Holter-ECG, exercise testing, and echocardiography).