title: Natriuresis and blood pressure reduction in hypertensive patients with diabetes mellitus: the NESTOR study.
abstract: The antihypertensive effect of indapamide has never been clearly understood, particularly in hypertensive patients with diabetes mellitus. A total of 565 patients were randomly selected to receive either indapamide 1.5 mg or enalapril 10 mg daily for 12 months. Brachial blood pressure (BP) and plasma and urinary electrolytes were measured at baseline and at the end of follow-up. Sodium and potassium levels and excretion rates were measured in overnight urine collections. After 12 months' treatment, similar significant reductions were observed in systolic and diastolic BP and pulse pressure levels in both treatment arms (P < .001). However, age, body mass index, diabetes duration, and plasma sodium reductions were shown to be major, independent factors influencing BP reduction with indapamide, but not with enalapril. Regression coefficients were positive for age and plasma sodium reductions (P ≤ .009) but negative for body mass index and diabetes duration (P ≤ .008). Similar findings were observed for pulse pressure. These results were more notable in elderly patients, did not differ regardless of whether BP reduction was measured in absolute or percent values, and were associated with increased sodium and potassium excretion rates.Indapamide is more effective than enalapril at reducing BP in elderly diabetic hypertensives with marked sodium retention.
authors.affiliation: Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Diagnosis and Therapeutic Center, Hotel-Dieu, Assistance Publique - Hopitaux de Paris, Paris Descartes University, Paris, France.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Diagnosis and Therapeutic Center, Hotel-Dieu, Assistance Publique - Hopitaux de Paris, Paris Descartes University, Paris, France.
authors.forename: Davide
authors.initials: D
authors.lastname: Agnoletti
authors.affiliation: Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Ji-Guang
authors.initials: JG
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Yawei
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Diagnosis and Therapeutic Center, Hotel-Dieu, Assistance Publique - Hopitaux de Paris, Paris Descartes University, Paris, France. Electronic address: michel.safar@htd.aphp.fr.
authors.forename: Michel E
authors.initials: ME
authors.lastname: Safar
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000503:physiopathology*; D004656:Enalapril / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007190:Indapamide / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009318:Natriuresis
chemical_list: D000959:Antihypertensive Agents; D004656:Enalapril; D007190:Indapamide
keywords: Blood pressure reduction; electrolyte excretion; enalapril; hypertension; indapamide