Indapamide A Review of its Pharmacodynamic Properties and Therapeutic Efficacy in Hypertension

Abstract

Indapamide is an orally active sulphonamide diuretic agent. Although some evidence appears to indicate that the antihypertensive action of indapamide is primarily a result of its diuretic activity, only a limited diuresis occurs with the usual antihypertensive doses of 2.5 mg daily, and in vitro and in vivo data suggest that it may also reduce blood pressure by decreasing vascular reactivity and peripheral vascular resistance. In mild to moderate hypertension it is as effective as thiazide diuretics and beta-adrenergic blocking agents in lowering blood pressure when used as the sole treatment. Indapamide has been successfully combined with beta-adrenergic blocking agents, methyldopa, and other anti-hypertensive agents. While such findings need confirmation, it appears that indapamide shares the potential with other diuretic agents to induce electrolyte and other metabolic abnormalities, although it may do so with less frequency or severity. Thus, indapamide appears to offer a suitable alternative to more established drugs as a 'first-line' treatment in patients with mild to moderate hypertension. Whether it differs significantly from other diuretics when used as antihypertensive therapy, either in its mode of action or its side effect profile, needs further clarification.

Blood pressure reduction for the secondary prevention of stroke: a Chinese trial and a systematic review of the literature

“…2 In Chinese patients with a history of cerebrovascular disease, antihypertensive treatment with the sulfonamide diuretic indapamide 16 at a daily dose of 2.5 mg lowered blood pressure by 6.8 mm Hg systolic and 3.3 mm Hg diastolic and reduced the incidence of stroke recurrence and combined fatal and nonfatal cardiovascular end points by 31 and 25%, respectively. These effects were consistent, irrespective of sex, median age, blood pressure status at randomization and subtype of the qualifying cerebrovascular event.…”

“…17 It was an investigator-initiated and investigator-led clinical trial with little funding. We used indapamide 16,18 because in the early 1990s this diuretic was one of the most commonly used generic antihypertensive drugs in China and also because it was very inexpensive. The Tientsin Lisheng Pharmaceutical Company (Tianjin, China) provided the active study medication and the matching placebo.…”

“…In vitro and in vivo studies in animals and humans showed that the blood-pressure-lowering action of indapamide not only involves increased natriuresis but inhibition of the contractile responses of vascular smooth muscle cells to vasopressors and adrenergic stimulation as well. 16,18 Diuretics 21,22 and calcium channel blockers 22,23 probably have a small 5-10% benefit beyond blood pressure lowering in the prevention of stroke. Unlike thiazide diuretics, indapamide, 18,24,25 as well as calcium channel blockers, inhibit the inward current of calcium across cell membranes and reduce intracellular calcium concentrations.…”

Serum lipoprotein levels during long-term treatment of hypertension with indapamide.

“…Compared to the high daily doses of 100 mg chlorthalidone or hydrochlorothiazide administered in several studies, 9 ' " • l 3 low-dose thiazides, 31 -32 that is, less than 12.5 mg daily, might possibly be as effective in antihypertensive therapy, as we demonstrated with 2.5 mg of indapamide, which caused fewer adverse metabolic consequences. 33 …”

Preliminary Investigation on the Development of Diltiazem Resin Complex Loaded Carboxymethyl Xanthan Beads

“…It has been reported that diltiazem hydrochloride, a calcium channel blocker is widely used for the treatment of angina pectoris (25,26), arrythmias and hypertension. Its short biological half life and thus frequent administration (usually three to four times a day) makes it a potential candidate for sustained release preparation (27,28).…”