[Antihypertensive action of indapamide in hypertension of chronic renal failure].
Indapamide, a molecule with moderate diuretic effect, is an efficient antihypertensive drug. Blood pressure control is mostly explained by a direct action on peripheral vascular resistance. This action on peripheral resistances, as opposed to that on sodium balance, has rarely been indisputably substantiated. In order to dissociate its diuretic effect from its activity on peripheral resistances, we undertook a study on the efficacy of adding indapamide to the antihypertensive regimen of 12 patients suffering from chronic renal failure complicated by hypertension, and in whom control of high blood pressure had not been achieved with one to four antihypertensive drugs, plus furesemide in case of overhydration. Renal insufficiency was defined by serum creatinine levels of (m +/- SD) 271 +/- 171 mumol/l and a glomerular filtration rate of 36.7 +/- 18.6 ml/min. Before indapamide was introduced, blood pressure was 172.4 +/- 23.1 mmHg/109.6 +/- 9.55 mmHg. After 1 to 6 months of treatment, blood pressure was normalised. Systolic BP was 141.6 +/- 19 mmHg (p < 0.001) and diastolic BP was 89.7 +/- 8.6 mmHg (p < 0.001). Absence of diuretic effect and/or of modification of water and electrolytes was verified by the stability of body weight and serum electrolytes. At end point, body weight, electrolytes and renal function were unchanged. This study confirms that indapamide exerts an antihypertensive effect by lowering peripheral vascular resistances and not by diminishing the volume of extracellular fluid. Indapamide can be listed among antihypertensive agents that are advisable in the treatment of high blood pressure in patients with chronic renal insufficiency. Its antihypertensive effect in such patients is independent of any natriuretic action.
Meyrier
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Service de Néphrologie, Hôpital Avicenne, Bobigny.
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D000553:Ambulatory Care; D000959:Antihypertensive Agents; D001581:Benzothiadiazines; D004232:Diuretics; D004341:Drug Evaluation; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000188:drug therapy*; D007190:Indapamide / Q000494:pharmacology / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D049993:Sodium Chloride Symporter Inhibitors / Q000494:pharmacology
D000959:Antihypertensive Agents; D001581:Benzothiadiazines; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D007190:Indapamide
Action antihypertensive de l'indapamide dans l'hypertension de l'insuffisance rénale chronique.