title: The effect of indapamide versus hydrochlorothiazide on ventricular and arterial function in patients with hypertension and diabetes: results of a randomized trial.
abstract: OBJECTIVE
  The objective of this study is to compare the effects of 2 types of diuretics, indapamide and hydrochlorothiazide, added to an angiotensin-converting enzyme inhibitor, on ventricular and arterial functions in patients with hypertension and diabetes.
  
  
  METHODS
  This is a prospective, randomized, active-controlled, PROBE design study in 56 patients (57 ± 9 years, 52% men) with mild-to-moderate hypertension and type 2 diabetes, with normal ejection fraction, randomized to either indapamide (1.5 mg Slow Release (SR)/day) or hydrochlorothiazide (25 mg/d), added to quinapril (10-40 mg/d). All patients had conventional, tissue Doppler and speckle tracking echocardiography and assessment of endothelial and arterial functions and biomarkers, at baseline and after 6 months.
  
  
  RESULTS
  Baseline characteristics were similar between groups; systolic and diastolic blood pressures decreased similarly, by 15% and 9% on indapamide and by 17% and 10% on hydrochlorothiazide (P < .05). Mean longitudinal systolic velocity and longitudinal strain increased by 7% and 14% on indapamide (from 5.6 ± 1.8 to 6.0 ± 1.1 cm/s and from 16.2% ± 1.8% to 18.5% ± 1.1%, both P < .05), but did not change on hydrochlorothiazide (P < .05 for intergroup differences), whereas ejection fraction and radial systolic function did not change. Similarly, mean longitudinal early diastolic velocity increased by 31% on indapamide (P < .05), but did not change on hydrochlorothiazide (P < .05 for intergroup differences). These changes were associated with improved endothelial and arterial functions on indapamide, but not on hydrochlorothiazide.
  
  
  CONCLUSIONS
  Indapamide was found to improve measures of endothelial and arterial functions and to increase longitudinal left ventricular function compared with hydrochlorothiazide in patients with hypertension and diabetes, after 6 months of treatment. This study suggests that indapamide, a thiazide-like diuretic, has important vascular effects that can improve ventriculoarterial coupling.
authors.affiliation: University of Medicine and Pharmacy Carol Davila, Bucharest, Romania. Electronic address: vinereanu@gmail.com.
authors.forename: Dragos
authors.initials: D
authors.lastname: Vinereanu
authors.affiliation: University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
authors.forename: Raluca
authors.initials: R
authors.lastname: Dulgheru
authors.affiliation: University and Emergency Hospital, Bucharest, Romania.
authors.forename: Stefania
authors.initials: S
authors.lastname: Magda
authors.affiliation: University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
authors.forename: Ruxandra
authors.initials: R
authors.lastname: Dragoi Galrinho
authors.affiliation: University and Emergency Hospital, Bucharest, Romania.
authors.forename: Maria
authors.initials: M
authors.lastname: Florescu
authors.affiliation: University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
authors.forename: Mircea
authors.initials: M
authors.lastname: Cinteza
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Christopher
authors.initials: C
authors.lastname: Granger
authors.affiliation: University of Medicine and Pharmacy Carol Davila, Bucharest, Romania; National Institute of Pathology Victor Babes.
authors.forename: Andrea O
authors.initials: AO
authors.lastname: Ciobanu
mesh_terms: D001794:Blood Pressure / Q000187:drug effects; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004232:Diuretics / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage*; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D007190:Indapamide / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014655:Vascular Resistance / Q000187:drug effects*; D016276:Ventricular Function / Q000187:drug effects*
chemical_list: D004232:Diuretics; D006852:Hydrochlorothiazide; D007190:Indapamide