Serum lipoproteins during treatment with the antihypertensive agent indapamide.

Abstract

SUMMARY Considering the documented, potentially undesirable influence of various thiazide-type or loop diuretics on serum lipoproteins, we prospectively investigated in 69 men (mean age ± SEM, 32 ± 1 years) the metabolic effects of the new diuretic-antihypertensive compound indapamide. Compared to placebo, indapamide (2.5 mg/day) given for 6 to 8 weeks lowered (p < 0.02 to < 0.001) blood pressure (supine values from 148/98 ± 3/2 to 137/93 ± 3/2) in 29 men with mild to moderate essential hypertension, but not in 40 healthy men. In both groups, significant (p < 0.05 to < 0.001) decreases in body weight ( -0.8 kg) and plasma potassium ( -0.6 mmol/L), and increases in plasma uric acid ( + 20%), renin activity ( + 200%), and aldosterone documented good compliance. There were no significant changes hi total cholesterol (in all subjects, from 208 ± 6 to 213 ± 6 mg/dl), low-or very low-density lipoprotein (VLDL) cholesterol (127 ± 6 to 129 ± 6 and 21 ± 1 to 21 ± 2 respectively), high-density lipoprotein cholesterol (50 ± 1 to 51 ± 1 mg/dl), total triglycerides (Tg) (108 ± 5 to 112 ± 6 mg/dl), VLDL-Tg, apoproteins Al and A2, plasma glucose, epinephrine, norepinephrine, sodium, calcium, magnesium, and creatinine; apoprotein B (84 ± 2 to 88 ± 3 mg/dl) and plasma insulin after glucose loading dose tended to be increased minimally. The absence of distinct lipoprotein alterations after short-term indapamide treatment may be of clinical and epidemiological interest.

Diuretic Treatment of Hypertension

“…Another thiazide-like diuretic that is less discussed is indapamide. This agent has less adverse effect on metabolic parameters than other diuretics (45,46), is more effective than enalapril in reducing left ventricular mass (47), is equivalent to enalapril in reducing microalbuminuria (48), and is effective in reducing CV morbidity and mortality in clinical trials (3,9,16,49). Thus, the use of indapamide as a leading diuretic agent may be worthwhile.…”

Drug Treatment of Hypertension in Patients With Diabetes Mellitus

“…The limited data on diabetic patients do not allow a conclusion regarding any enhanced susceptibility in terms of thiazide-induced alterations in serum lipid levels. Indapamide has been reported to have less effect on plasma lipids (228). Thus, the effects on plasma lipids are variable, and their significance must be assessed by long-term studies comparing thiazides to other antihypertensives and determining whether these adverse metabolic effects persist and are associated with clinical end points.…”

Optimizing cardiovascular risk reduction during antihypertensive therapy.

“…52 Indapamide has also been reported not to cause hypokalemia at doses of 2.5 mg/day or less in one study, 53 but in two other studies, a slight but statistically significant decrease was seen at the same dose. 54 - 55 Administration of copious amounts of supplemental potassium (60-120 meq/day) or potassium-sparing agents can prevent diuretic-induced hypokalemia. However, the expense and relative unpalatability of the former and the potential side effects and variable efficacy of the latter often make these approaches unsatisfactory.…”