Angiotensin converting enzyme Inhibitors (ACEIs) are reported to have a lower efficacy in black hypertensive patients, particularly in monotherapy. However, no studies have examined the efficacy of ACEIs in a Caribbean population. A dose titration study was performed with perindopril in the English and Dutch Caribbean islands to assess the efficacy and acceptability of Perindopril in this population. 435 patients with essential hypertension, with a diastolic BP between 95 and 125 mmHg were enrolled into this 3-month open study. Out of 333 patients who completed this study, 285 patients (69.3 per cent) were successfully controlled (diastolic BP<90 mmHg). An additional 45 (7.81 per cent) patients were controlled with the addition of hydrochlorothiazide 25 mg. Supine BP was reduced from 168.2 mmHg (+/- 1.08) systolic and 105.6 mmHg (+/- .48) diastolic to 149.12 mmHg (+/- 0.98) systolic and 91.95 mmHg (+/- 0.55) diastolic (p<0.001) after 2 months of perindopril in monotherapy. Supine BP was reduced further at the end of the 3-month treatment period to 144.3 mmHg (+/- 0.91) systolic and 88.39 mmHg (+/- 0.46) diastolic (p<0.001). There was no significant difference between the black population and the total population. Perindopril was well tolerated with a low reported incidence of cough. Withdrawal due to adverse events was also low at 2.3 per cent (10 patients). The anti-hypertensive efficacy of perindopril in a Caribbean population and more specifically, the black Caribbean population with mild to moderate hypertension, is confirmed in this study together with its clinical and biological acceptability