Comparative assessment of hypotensive, metabolic, and endothelial effects of indapamide-retard and hydrochlorothiazide in patients with essential hypertension

Aim. To compare hypotensive, metabolic, and endothelial effects of indapamide-retard and hydrochlorothiazide. material and methods. Patients (n=50) with essential hypertension were given either indapamide-retard (1.5 mg/day, n=25) or hydrochlorothiazide (25 mg/day, n=25) for 12 weeks. Dynamics of the following parameters were studied: blood pressure, blood lipids and glucose, total coronary risk, carotid artery intima-media thickness, reaction of brachial artery to endothelium-dependent and endothelium-independent stimuli registered by high resolution ultrasound. Results. Indapamide-retard and hydrochlorothiazide demonstrated similar hypotensive efficacy. Indapamide-retard turned out to be metabolically neutral while in patients receiving hydrochlorothiazide we observed significant elevation of triglycerides (+15.3%, p < 0.05) and glucose (+12.2%, p < 0.05). This resulted in the lack of lowering of total coronary risk during treatment with hydrochlorothiazide. Significant intergroup differences were revealed in effects on endothelium-dependent vasodilation with tendency to improvement and to significant worsening (-17%, p < 0.05) in indapamide and hydrochlorothiazide treated patients, respectively. Conclusion. Despite similar hypotensive efficacy there were significant differences in metabolic and endothelial effects of 2 diuretics in favor of indapamide. This could potentially matter for long term cardiovascular prognosis.