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[Renaissance of diuretics in the treatment of hypertension]
1Klinische Abteilung für Nephrologie und Dialyse, Medizinische Universitätsklinik III, AKH Wien, Osterreich.
Insights
Low-dose indapamide sustained-release (SR) significantly reduces hypokalemia compared to immediate-release (IR) formulation. This new formulation offers an improved safety profile for hypertension management, especially in the elderly.
Area of Science:
- Cardiology
- Pharmacology
- Nephrology
Context:
- Diuretics and beta-blockers are established antihypertensives reducing cardiovascular events, particularly in elderly populations.
- Low-dose diuretic therapy enhances the efficacy-safety ratio, minimizing dose-dependent side effects like hypokalemia and metabolic disturbances.
Purpose:
- To evaluate a novel low-dose sustained-release (SR) indapamide formulation (1.5 mg/day) against its immediate-release (IR) counterpart (2.5 mg/day).
- To assess the safety and efficacy of indapamide SR in hypertensive patients, focusing on serum potassium levels and left ventricular mass index (LVMI).
Summary:
- A >50% reduction in hypokalemia (< 3.4 mmol/l) was observed with indapamide SR compared to IR.
- The LIVE study demonstrated indapamide SR's efficacy in reducing LVMI in hypertensive patients over one year, comparable to higher doses of enalapril.
Impact:
- Low-dose indapamide SR presents an improved safety profile, particularly regarding electrolyte balance.
- Supports international recommendations for low-dose antihypertensives as a first-line therapy for hypertension, offering a safer alternative for elderly patients.
Abstract:
Diuretics and beta-blockers are the only antihypertensives known for their significant reduction of cardiovascular morbidity and mortality, particularly in the elderly. The use of low-dose diuretics can improve the efficacy-safety ratio. Hypokalemia, hypomagnesemia as well as disturbances of carbohydrate and lipid metabolism are dose-dependent side effects of diuretics but only minimal during the low-dose therapy. A novel low-dose formulation of indapamide was developed as a sustained-release (SR) coated tablet (1.5 mg/day) and compared to the immediate release (IR) formulation of indapamide (2.5 mg/day). A > 50% reduction in the number of patients with serum potassium levels < 3.4 mmol/l among hypertensive patients treated with indapamide SR as compared to IR was observed. Indapamide SR has also been shown to be effective (more than 20 mg enalapril) in the reduction of left ventricular mass index (LVMI) in hypertensive patients treated for one year (LIVE study). Therefore, low-dose diuretics are, in accordance with international recommendations for the low-dose antihypertensive drugs, a first line therapy of hypertension.