Effects of indapamide on left ventricular mass and function in systemic hypertension with left ventricular hypertrophy

Abstract

Left ventricular hypertrophy (LVH) is frequently associated with hypertension and constitutes a major cardiovascular risk factor, the reduction of which should be considered when initiating antihypertensive therapy. To assess the effects of indapamide on LVH, 18 hypertensive patients were included in the study (11 men and 7 women, age 53.6 ± 2.9 years, mean ± standard deviation) whose supine diastolic blood pressure was greater than 95 mm Hg without (n = 11) or with (n = 7:6 β blockers, 1 calcium antagonist) antihypertensive therapy. All presented with LVH, echocardiographically defined by a left ventricular mass index greater than 110 g/m 2. After a 2-week preinclusion period, all patients received indapamide, 2.5 mg/day, for a period of 6 months. Physical examination including blood pressure measurement was performed on selection ( M- 1 2 ), before (MO), and after 1 (M1), 3 (M3) and 6 (M6) months of indapamide treatment, and echocardiography was performed at MO and M6. Quality of life was evaluated by means of questionnaires completed by the patient and the physician, and a visual analog scale was completed by the patient at M- 1 2 , MO and M6. All clinical parameters remained stable during the 2-week preinclusion period. Indapamide administration induced a highly significant reduction in both supine systolic and diastolic blood pressures from 173.9 ± 2.9/100.5 ± 1.2 mm Hg at MO to 150.9 ± 1.9/90.5 ± 1.3 mm Hg at M1 (p < 0.001), and 145.0 ± 1.7/86.0 ± 1.5 mm Hg at M6 (p < 0.001). Similar favorable effects were observed in the upright position. Echocardiography showed a significant reduction in left ventricular mass index, from 174.4 ±6.1 g/m 2 at MO to 146.2 ± 6.0 at M6 (p < 0.001). Diastolic posterior wall thickness and interventricular wall thickness were significantly reduced from 12.0 ± 0.3/13.1 ± 0.4 mm at MO to 10.9 ± 0.2/11.5 ± 0.3 mm at M6 (p < 0.001). Fractional shortening remained stable during treatment. The 2 quality of life questionnaires completed, respectively, by the patient and by the physician both evidenced a significant improvement during indapamide therapy; a general well-being score on visual analog scale increased from 5.4 ± 6.4 to 23.4 ± 6.4 (p < 0.01). Biochemical acceptability was satisfactory, with no significant changes in total cholesterol and high-density, low-density and very low density lipoprotein fractions. These results show that indapamide exerts a significant antihypertensive activity with a good clinical acceptability and induces a beneficial reduction in left ventricular hypertrophy.