Key result
Indapamide raises total cholesterol ~5% less than high-dose thiazides while lowering SBP equally.
Why the study?
Does indapamide prevent adverse lipid effects compared to thiazides while effectively lowering blood pressure in patients with systemic hypertension?
Meta-Analysis (n=1,547)
Does indapamide prevent adverse lipid effects compared to thiazides while effectively lowering blood pressure in patients with systemic hypertension?
Absolute Event Rate: 1.4% vs 6.3%
p-value: p=<0.01
Indapamide provides comparable blood pressure reduction to thiazides without the dose-dependent adverse effects on total cholesterol and triglycerides seen with thiazide diuretics.
Indapamide may be preferred over high-dose thiazides to limit lipid rises in hypertension; confirms its metabolic advantages with equivalent systolic BP reduction.
Thiazide diuretics in high dosage adversely affect the lipid profile. The non-thiazide indoline, indapamide, appears to be free of this effect, but it is unclear whether this apparent metabolic advantage of indapamide is superior to thiazides used in low dose. Since there are no large direct comparative studies to test this distinction, I surveyed the literature and pooled the findings of all published reports giving data on lipid and blood pressure effects of thiazides in various doses and of both indapamide, 2.5 mg daily, used as monotherapy of hypertension. I found 31 reports of thiazides; 12 of them examined low-dose regimens, i.e., < or = 25 mg/day of hydrochlorothiazide or its equivalent in other thiazides. Larger doses of thiazides were tested in 19 studies (median daily dose of 50 mg, maximum dose of 112.5 mg). There were 430 subjects in the low-dose studies and 559 subjects in the high-dose regimens. There were 13 studies of indapamide, comprising 558 subjects. Regarding lipids, total cholesterol increased from baseline by 1.4% on indapamide, 3.8% on low-dose thiazides, and 6.3% on high-dose thiazides, The change from baseline was significantly greater for high-dose thiazides than for indapamide (p<0.01). Changes in high-density lipoprotein cholesterol did not differ among groups. The change in triglycerides differed among regimens, -0.5%, 10.8%, and 19.5% for indapamide, low-dose thiazides, and high-dose thiazides, respectively (p<0.01). Systolic blood pressure (SBP) decreased by 13 and 18 mm Hg on low-dose and high-dose thiazides, respectively (p<0.05 between doses). Indapamide lowered SBP by 16 mm Hg, not different from either thiazide dose. Diastolic blood pressure did not differ among groups. From these noncomparative studies, I conclude that (1) indapamide has no adverse lipid effect and lowers blood pressure equally to thiazides; (2) thiazide effects on lipids and SBP are dose-dependent; and (3) thiazides adversely affect the lipid profile even in low dose.
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Richard P. Ames (1996) conducted a meta-analysis in Systemic hypertension (n=1,547). Indapamide vs. Low-dose and high-dose thiazides was evaluated on Change in total cholesterol from baseline (p=<0.01). Indapamide increased total cholesterol by 1.4% from baseline, significantly less than the 6.3% increase seen with high-dose thiazides (p<0.01), while lowering systolic blood pressure equally.
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