Efficacy of hydrochlorothiazide and indapamide in the treatment of arterial hypertension in rutine ambulatory practice


DOI: https://dx.doi.org/10.18565/therapy.2020.7.113-119

Minushkina L.O.

Central State Medical Academy of the Administrative Department of the Presidential Affairs of the Russian Federation, Moscow
The article analyzes the use of thiazide and thiazide-like diuretics in routine outpatient practice. The data of the active observation group of 409 patients with arterial hypertension (157 (38,4%) males and 252 (61,6%) females, average age 58,58±9,914 years) were analyzed. All patients underwent office monitoring of blood pressure (BP), estimation of inter-visit BP variability, 24-hour BP monitoring. It has been shown that thiazide and thiazide-like diuretics are not used in monotherapy. Against the background of combined therapy with indapamide and hydrochlorothiazide use, the values of the achieved office BP and 24-hour BP monitoring indexes did not differ significantly. At the same time, the variability of systolic blood pressure with indapamide use was significantly less than with use of hydrochlorothiazide: 7,84±3,578 versus 10,64 ± 5,242 mm Hg. respectively (p=0,030). Against the background of indapamide treatment, there was a tendency for larger decrease in nighttime blood pressure values, which is illustrated by the clinical case presented in the article. The presented data allow us to speak about the best control of blood pressure in clinical practice in case of indapamide intake.
Keywords: arterial hypertension, thiazide diuretics, thiazide-like diuretics, blood pressure variability
Read entire article

Literature


  1. Клинические рекомендации «Артериальная гипертензия у взрослых». Российское кардиологическое общество. 2020; 136 с. Доступ: https://scardio.ru/content/Guidelines/Clinic_rek_AG_2020.pdf (дата обращения – 01.10.2020). [Clinical guidelines «Arterial hypertension in adults». Russian Cardiologic Society. 2020; 136 p. URL: https://scardio.ru/content/Guidelines/Clinic_rek_AG_2020.pdf (date of access – 01.10.2020) (In Russ.)].

  2. Williams B., Mancia G., Spiering W. et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018; 36(10): 1953–2041. doi: 10.1097/HJH.0000000000001940.

  3. Thomopoulos C., Parati G., Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 4. Effects of various classes of antihypertensive drugs – overview and meta-analyses. J Hypertens. 2015; 33(2): 195–211. doi: 10.1097/HJH.0000000000000447.

  4. Руководство по артериальной гипертонии. Под ред. Е.И. Чазова, И.Е. Чазовой. М.: Медиа Медика. 2005; 784 с. [Arterial hypertension guide. Ed. by Chazov E.I., Chazova I.E. M.: Media Medica. 2005; 784 p. (In Russ.)].

  5. Roush G.C., Abdelfattah R., Song S. et al. Hydrochlorothiazide vs chlorthalidone, indapamide, and potassium-sparing/hydrochlorothiazide diuretics for reducing left ventricular hypertrophy: A systematic review and meta-analysis. J Clin Hypertens (Greenwich). 2018; 20(10): 1507–15. doi: 10.1111/jch.13386.

  6. Liang W., Ma H., Cao L. et al. Comparison of thiazide-like diuretics versus thiazide-type diuretics: a meta-analysis. J Cell Mol Med. 2017; 21(11): 2634–42. doi: 10.1111/jcmm.13205.

  7. Arroll B., Wallace H. Should we switch from bendrofluazide to chlorthalidone as the initial treatment for hypertension? A review of the available medication. J Prim Health Care. 2017; 9(2): 105–13. doi: 10.1071/HC16038.

  8. Roush G.C., Ernst M.E., Kostis J.B. et al. Head-to-head comparisons of hydrochlorothiazide with indapamide and chlorthalidone: antihypertensive and metabolic effects. Hypertension. 2015; 65(5): 1041–46. doi: 10.1161/HYPERTENSIONAHA.114.05021.

  9. Zhang Y., Agnoletti D., Safar M.E., Blacher J. Effect of antihypertensive agents on blood pressure variability: the Natrilix SR versus candesartan and amlodipine in the reduction of systolic blood pressure in hypertensive patients (X-CELLENT) study. Hypertension. 2011; 58(2): 155–60. doi: 10.1161/HYPERTENSIONAHA.111.174383.

  10. Muntner P., Whittle J., Lynch A.I. et al. Visit-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure, and mortality: A cohort study. Ann Intern Med. 2015; 163(5): 329–38. doi: 10.7326/M14-2803.

  11. Ohkubo T., Kikuya M., Metoki H. et al. Prognosis of «masked» hypertension and «white-coat» hypertension detected by 24-h ambulatory blood pressure monitoring 10-year follow-up from the Ohasama study. J Am Coll Cardiol. 2005; 46(3): 508–15. doi: 10.1016/j.jacc.2005.03.070.

  12. Скибицкий В.В., Фендрикова А.В., Сиротенко Д.В., Скибицкий А.В. Хронотерапевтические аспекты эффективности азилсартана медоксомила в составе комбинированной терапии у пациентов с артериальной гипертонией и метаболическим синдромом. Кардиология. 2016; 10: 35–40. [Skibitskiy V.V., Fendrikova A.V., Sirotenko D.V., Skibitskiy A.V. Hronotherapy aspects of efficiency azilsartan medoxomil in combination therapy in patients with hypertension and metabolic syndrome. Kardiologiya. 2016; 10: 35–40 (In Russ.)]. doi: 10.18565/cardio.2016.10.35-40.

  13. Ткачева О.Н., Рунихина Н.К., Котовская Ю.В. с соавт. Лечение артериальной гипертонии у пациентов 80 лет и старше и пациентов со старческой астенией. Кардиоваскулярная терапия и профилактика. 2017; 1: 8–21. [Tkacheva O.N., Runikhina N.K., Kotovskaya Yu.V. et al. Arterial hypertension management in patients aged older than 80 years and patients with the senile asthenia. Kardiovasculyarnaya terapiya i profilaktika. 2017; 1: 8–21 (In Russ.)]. doi: 10.15829/1728-8800-2017-1-8-21.


About the Autors

Larisa O. Minushkina, MD, professor of the Department of therapy, cardiology and functional diagnostics of Central State Medical Academy of the Administrative Department of the Presidential Affairs of the Russian Federation. Address: 121359, Moscow, 19/1A Marshala Timoshenko Str. Tel.: +7 (495) 530-05-17. E-mail: minushkina@mail.ru

Back to Content

Бионика Медиа