Key result
Delapril and indapamide combination therapy yielded a higher proportion of patients with normalized blood pressure (P=0.024) and responders (P=0.002) compared to ACEi plus hydrochlorothiazide.
Why the study?
Does delapril/indapamide combination improve blood pressure normalization compared to ACEi/HCTZ combinations in patients with mild-to-moderate hypertension?
Meta-Analysis (n=1,272)
Does delapril/indapamide combination improve blood pressure normalization compared to ACEi/HCTZ combinations in patients with mild-to-moderate hypertension?
p-value: p=0.024
The combination of delapril and indapamide provides superior blood pressure normalization and better tolerability compared to ACEi/HCTZ combinations in mild-to-moderate hypertension.
Supports delapril/indapamide preference for BP control in hypertension; extends meta-analytic evidence favoring indapamide over hydrochlorothiazide in ACEi regimens.
The main objective of this meta-analysis was to compare the efficacy of the combination of delapril and indapamide (D+I) to different angiotensin-converting enzyme inhibitor (ACEi) plus hydrochlorothiazide (HCTZ) combinations for the treatment of mild-to-moderate hypertension. A secondary objective was to examine the safety of these two combinations. Studies comparing the efficacy of D+I to ACEi+HCTZ combinations in hypertensive patients and published on computerized databases (1974-2010) were considered. Endpoints included percentage of normalized patients, of responders, change in diastolic and systolic blood pressure (DBP/SBP) at different time-points, percentage of adverse events (AEs), and percentage of withdrawal. Four head-to-head randomized controlled trials (D+I-treated, n = 643; ACEi+HCTZ-treated, n = 629) were included. Meta-analysis indicated that D+I-treated patients had a higher proportion with normalized blood pressure (P = 0.024) or responders (P = 0.002) compared to ACEi+HCTZ-treated patients. No difference was observed between treatments on absolute values of DBP and SBP at different time-points. Although the rate of patients reporting at least one AE was similar in both groups (10.4% versus 9.9%), events leading to study withdrawal were lower in the D+I group versus the ACEi+HCTZ group (2.3% versus 4.8%, respectively; P = 0.018). This meta-analysis suggests that treatment with D+I could provide a higher proportion of normalized or responder patients with good tolerability compared to ACEi+HCTZ combinations.
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Circelli et al. (2012) conducted a meta-analysis in mild-to-moderate hypertension (n=1,272). delapril and indapamide (D+I) vs. angiotensin-converting enzyme inhibitor (ACEi) plus hydrochlorothiazide (HCTZ) combinations was evaluated on percentage of normalized patients (p=0.024). Delapril and indapamide combination therapy yielded a higher proportion of patients with normalized blood pressure (P=0.024) and responders (P=0.002) compared to ACEi plus hydrochlorothiazide.
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