Efficacy of indapamide SR compared with enalapril in elderly hypertensive patients with type 2 diabetes.
BACKGROUND
Blood pressure control is the main influential variable in reducing microalbuminuria in patients with type 2 diabetes. In this subanalysis of the Natrilix SR versus Enalapril Study in hypertensive Type 2 diabetics with micrOalbuminuRia (NESTOR) study, we have compared the effectiveness of indapamide sustained release (SR) and enalapril in reducing blood pressure and microalbuminuria in patients > or =65 years of age.


METHODS
Of the 570 hypertensive patients with type 2 diabetes and persistent microalbuminuria in the NESTOR study, 187 (33%) individuals > or =65 years of age were included in this analysis. Of these, 95 patients received indapamide SR 1.5 mg and 92 patients received enalapril 10 mg, taken once daily in both cases. Adjunctive amlodipine and/or atenolol was added if required.


RESULTS
The urinary albumin-to-creatinine ratio decreased by 46% in the indapamide SR group and 47% in the enalapril group. Noninferiority of indapamide SR over enalapril was demonstrated (P = .0236; 35% limit of noninferiority) with a ratio of 0.95 (95% CI: 0.68, 1.34). Mean arterial pressure decreased by 18 mm Hg and 15 mm Hg in the indapamide SR and the enalapril groups, respectively (P = .1136). The effects of both treatments seen in these elderly patients were similar to those observed in the main population, although the extent of the reduction in microalbuminuria was slightly higher. Both treatments were well tolerated, and no difference between groups was observed regarding glucose or lipid profiles.


CONCLUSIONS
Indapamide SR is not less effective than enalapril in reducing microalbuminuria and blood pressure in patients aged >65 years of age with type 2 diabetes and hypertension.
Puig
Juan Garcia
JG
Servicio de Medicina Interna, Hospital La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain. jgarciapuig@terra.es
Marre
Michel
M
Kokot
Franciszek
F
Fernandez
Margarita
M
Jermendy
György
G
Opie
Lionel
L
Moyseev
Valentin
V
Scheen
André
A
Ionescu-Tirgoviste
Constantin
C
Saldanha
M Helena
MH
Halabe
Aaron
A
Williams
Bryan
B
Mion
Decio
D
Ruiz
Maximino
M
Hermansen
Kjeld
K
Tuomilehto
Jaakko
J
Finizola
Bartolomé
B
Gallois
Yves
Y
Amouyel
Philippe
P
Ollivier
Jean-Pierre
JP
Asmar
Roland
R
D000368:Aged; D000419:Albuminuria / Q000188:drug therapy*; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004656:Enalapril / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007190:Indapamide / Q000009:adverse effects / Q000627:therapeutic use*; D007677:Kidney Function Tests; D008297:Male
D000959:Antihypertensive Agents; D004656:Enalapril; D007190:Indapamide