Key result
Adding indapamide to perindopril is linked to an additional ~6 mmHg SBP reduction at week 8.
Why the study?
The study was conducted to assess the effectiveness of combining indapamide prolonged release and perindopril using blood pressure records collected in routine practice.
Does adding indapamide prolonged-release 1.5 mg to perindopril reduce systolic blood pressure in adults with uncontrolled hypertension compared to perindopril monotherapy?
Cohort (n=14,764)
Yes
Does adding indapamide prolonged-release 1.5 mg to perindopril reduce systolic blood pressure in adults with uncontrolled hypertension compared to perindopril monotherapy?
A target trial emulation using real-world data demonstrated that adding indapamide to perindopril yields clinically meaningful reductions in systolic blood pressure compared to continuing perindopril monotherapy.
Indapamide addition was associated with further SBP reduction; supports consensus on combination therapy but leaves open randomized confirmation.
Objective To assess the effectiveness of indapamide prolonged release and perindopril in combination using blood pressure (BP) records collected in routine practice. Methods Using a target trial emulation framework, an observational retrospective cohort study was conducted. The data source was the United Kingdom's CPRD Aurum general practice database. Adults with systolic BP (SBP) ≥ 145 mmHg treated with perindopril 4/5 mg for ≥ 4 weeks at a stable dose who either added indapamide 1.5 mg to perindopril ( n = 193) or continued on perindopril monotherapy ( n = 14 571) were included. Balance between treatment arms was achieved with propensity score matching; results were explored in additional analyses using different eligibility criteria and alternative statistical methodologies. The primary outcome was change in SBP from baseline to Week 8 between indapamide added to perindopril versus perindopril monotherapy. Results In the primary analysis, indapamide added to perindopril yielded an additional SBP reduction of −6.3 mmHg (95% confidence interval [CI] −8.7 to −3.9) over perindopril monotherapy at Week 8. Results of additional analyses were consistent with the main analysis, but effect estimates varied due to diverse underlying assumptions. Conclusions Target trial emulation allowed assessment of antihypertensive treatment effectiveness, and indapamide plus perindopril yielded clinically meaningful decreases in SBP over perindopril monotherapy. Secondary and sensitivity analyses support that these findings were robust.
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Darricarrère et al. (2026) conducted a cohort in Uncontrolled hypertension (n=14,764). Indapamide prolonged-release added to perindopril vs. Perindopril monotherapy (4 or 5 mg) was evaluated on Change in systolic blood pressure (SBP) from baseline to Week 8 (MD -6.3 mmHg, 95% CI -8.7 to -3.9). Adding indapamide prolonged-release to perindopril yielded an additional systolic blood pressure reduction of 6.3 mmHg at week 8 compared to continuing perindopril monotherapy.
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