Regression of left ventricular hypertrophy in hypertension with indapamide

Abstract

In hypertensive patients, the development of left ventricular hypertrophy seems to increase the risk of cardiovascular death. Although some antihypertensive agents have been associated with regression in left ventricular hypertrophy, diuretics, the most widely used ones, have not. Indapamide is a new, nonthiazide diuretic and vasodilator. To test its effects on left ventricular hypertrophy, patients with essential hypertension and left ventricular hypertrophy were studied before and at the end of 6 months of therapy with 2.5 mg of indapamide daily. Candidates had to have moderate, uncontrolled essential hypertension with echocardiographically documented left ventricular hypertrophy (left ventricular mass index ≥130 gm/m 2 for men and ≥ 110 gm/m 2 for women). Patients with complicated hypertension or with significant cardiovascular or metabolic diseases were excluded. Patients could remain on antihypertensive drugs other than diuretics, provided doses remained stable for 3 months before entry and there was no know regression of left ventricular hypertrophy. Of 13 patients selected, 2 dropped out. The remaining 11 patients successfully completed 6 months of therapy. The average age was 56 ± 10 years. Indapamide was associated with a significant reduction of mean systolic blood pressure from 172 to 142 mm Hg ( p < 0.001), diastolic blood pressure from 101 to 83 mm Hg ( p < 0.001), and left ventricular mass index from 146 ± 22 to 124 ± 22 gm/m 2 (mean ± SD) ( p < 0.003). The mean serum potassium level dropped from 4.3 to 3.6 mmol/L ( p < 0.001), and the mean serum uric acid level increased slightly from 368 to 430 μmol/L. There was no significant change in hematocrit, fasting blood sugar, and cholesterol levels and body weight. The mechanism by which indapamide had provoked a regression in left ventricular hypertrophy is not yet known. Different theories have been proposed for other antihypertensive agents. In our study, indapamide was well tolerated and effective in reducing both blood pressure and left ventricular mass in patients with essential hypertension and left ventricular hypertrophy.