Key result
Amlodipine, candesartan, and indapamide similarly reduced peripheral and central BP compared with placebo, but only indapamide significantly increased pulse pressure amplification (P=0.02).
Why the study?
Does amlodipine, candesartan, or indapamide improve central blood pressure and pulse pressure amplification compared to placebo in out-patients with essential hypertension?
RCT (n=145)
double-blinded
randomized
Yes
Does amlodipine, candesartan, or indapamide improve central blood pressure and pulse pressure amplification compared to placebo in out-patients with essential hypertension?
p-value: p=0.02
In patients with essential hypertension, amlodipine, candesartan, and indapamide similarly reduce central and peripheral blood pressure, but only indapamide significantly increases pulse pressure amplification.
Indapamide may offer vascular benefits beyond BP reduction; extends evidence on differential central hemodynamic effects among antihypertensives.
BACKGROUND: Central blood pressure (BP) is considered a better predictor of cardiovascular events than brachial BP. Modifications of central, beyond brachial BP, can be assessed by pressure amplification, a potential new cardiovascular risk factor. Comparison between drugs' effect on central hemodynamics has been poorly studied. Our aim was to assess the hemodynamic effect of a 12-week treatment with amlodipine 5mg, or candesartan 8mg, or indapamide sustained-release 1.5mg, in comparison with placebo. METHODS: We analyzed 145 out-patients with essential hypertension in primary prevention enrolled in the Natrilix SR Versus Candesartan and Amlodipine in the Reduction of Systolic Blood Pressure in Hypertensive Patients (X-CELLENT) study, a multicenter, randomized, double-blinded, placebo-controlled trial. Arterial stiffness, central BP, pressure amplification, and wave reflection were measured by applanation tonometry. RESULTS: Baseline characteristics of patients were homogeneous between groups. After treatment, we found that active drugs produced similar reduction of both central and peripheral BPs, with no significant interdrug differences (all P < 0.05; excluded peripheral pulse pressure, compared with placebo). Second, amlodipine (1.9% ± 15.3%), candesartan (3.0% ± 14.6%) and indapamide (4.1% ± 14.4%) all increased pulse pressure amplification, but only indapamide was statistically different from placebo (P = 0.02). Finally, no significant changes were observed on pulse wave velocity, heart rate, and augmentation index. CONCLUSIONS: The 3 antihypertensive drugs similarly reduced peripheral and central BP, as compared with placebo, but a significant increase in pulse pressure amplification was obtained only with indapamide, independently of arterial stiffness modifications. REGISTRATION NUMBER: 3283161 by BIOPHARMA.
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Agnoletti et al. (2013) conducted an RCT in essential hypertension (n=145). Amlodipine, candesartan, or indapamide sustained-release vs. Placebo was evaluated on Central and peripheral blood pressure and pulse pressure amplification (p=0.02). Amlodipine, candesartan, and indapamide similarly reduced peripheral and central BP compared with placebo, but only indapamide significantly increased pulse pressure amplification (P=0.02).
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