Key result
Long-term indapamide reduces all-cause mortality ~15% versus placebo, alongside fewer CV deaths and fatal strokes.
Why the study?
To assess the improvement in all-cause death and cardiovascular outcomes associated with indapamide as a blood pressure-lowering drug in randomised controlled trials.
Does indapamide-based treatment reduce all-cause mortality, cardiovascular death, and fatal stroke in adults with at least one major cardiovascular risk factor?
Meta-Analysis (n=24,194)
Yes
Does indapamide-based treatment reduce all-cause mortality, cardiovascular death, and fatal stroke in adults with at least one major cardiovascular risk factor?
Indapamide-based blood pressure lowering significantly reduces all-cause mortality, cardiovascular death, and fatal stroke in high-risk cardiovascular patients.
Supports indapamide-based regimens to reduce mortality in high-risk patients; reinforces meta-analytic evidence for thiazide-like diuretics.
Objective: To assess the improvement in all-cause death and cardiovascular outcomes associated with the administration of the thiazide-like diuretic indapamide as a blood pressure-lowering drug in randomised controlled trials. Design and method: Literature was searched for all long-term morbidity-mortality trials that compared indapamide (alone or in combination with perindopril tert-butylamine) with placebo in adult individuals having at least one major cardiovascular risk factor. The endpoints included all-cause mortality, cardiovascular death, and fatal stroke. A meta-analysis (fixed and randomised effects) was run on the data that was extracted by 2 independent reviewers. Results: Four international trials conducted versus placebo met the selection criteria: PATS, a 2-year Chinese study (indapamide 2.5 mg daily), and PROGRESS, a 4-year international study (indapamide 2.5 mg plus perindopril 4 mg), both in patients with a history of stroke or transient ischemic attack; HYVET, a 2-year international study in elderly hypertensives (indapamide SR 1.5 mg plus option of 2–4 mg perindopril), and ADVANCE, a 4-year international study in patients with type 2 diabetes + cardiovascular risk factor (single-pill combination: perindopril 4 mg/indapamide 1.25 mg). Number of patients at risk were the following: PATS (Indapamide [Ind] = 2841; Placebo [Plc] = 2824), PROGRESS (Ind = 1770; Plc = 1774), HYVET (Ind = 1933; Plc = 1912), ADVANCE (Ind = 5569; Plc = 5571). The fixed-effects meta-analysis of the 3 mortality endpoints found low heterogeneity. The hazard ratios (HR) indicated statistically significant reductions in risks in the indapamide-treated patients as compared to the placebo-treated patients (Table).Conclusions: In relatively diverse patient populations, long-term indapamide treatment provided a 15% risk reduction in all-cause mortality, a 21% reduction in cardiovascular death and a 37% reduction in fatal stroke.
No takes yet. Share an insight, caveat, or question.
Chalmers et al. (2019) conducted a meta-analysis in Cardiovascular risk factors (n=24,194). Indapamide (alone or in combination with perindopril) vs. Placebo was evaluated on All-cause mortality, cardiovascular death, and fatal stroke (HR 0.85 (all-cause mortality), HR 0.79 (CV death), HR 0.63 (fatal stroke)). Long-term indapamide treatment significantly reduced all-cause mortality by 15%, cardiovascular death by 21%, and fatal stroke by 37% compared to placebo.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: