title: Treatment of Hypertensive Patients With Diabetes and Microalbuminuria With Combination Indapamide SR/Amlodipine: Retrospective Analysis of NESTOR.
abstract: BACKGROUND
  Combination treatments for hypertension most often include a renin-angiotensin-aldosterone system (RAAS) inhibitor. However, systolic blood pressure (SBP) remains difficult to control. Non-RAAS-inhibiting strategies such as calcium channel blocker/thiazide-like diuretic combinations may offer effective alternatives.
  
  
  METHODS
  Hypertensive diabetic patients with microalbuminuria were included in this retrospective, post-hoc analysis of the Natrilix SR Versus Enalapril Study in Hypertensive Type 2 Diabetics With MicrOalbuminuRia (NESTOR) trial if they were uncontrolled on monotherapy (indapamide slow release (SR) 1.5 mg or enalapril 10mg) and had been given add-on amlodipine 5 mg. Patients uncontrolled with monotherapy/amlodipine 5mg were uptitrated to 10 mg.
  
  
  RESULTS
  After 52 weeks, supine SBP/diastolic BP (DBP) decreased from baseline by 26±13/14±9 mm Hg in the indapamide SR/amlodipine group (n = 135) and by 21±14/11±9 mm Hg in the enalapril/amlodipine group (n = 156) (P = 0.006 for ΔSBP). In the amlodipine 10mg subgroup, SBP/DBP decreased from baseline by 26±13/13±9 mm Hg in the indapamide SR/amlodipine group (n = 62) and by 20±13/12±8 mm Hg in the enalapril/amlodipine group (n = 77) (P = 0.02 for ΔSBP). Treatment with indapamide SR/amlodipine was well tolerated. Few patients experienced edema, with no between-group differences. As expected with diuretics, slight changes in kalemia and in uricemia were observed in the indapamide SR/amlodipine group. Changes in fasting glucose, lipids, natremia, and creatinine clearance were similar between groups.
  
  
  CONCLUSIONS
  Indapamide SR/amlodipine results in superior SBP reduction with a safety profile in line with that of its components and tolerability equivalent to that of an angiotensin-converting enzyme inhibitor/amlodipine strategy.
authors: Université Paris Descartes, Sorbonne Paris Cité, EA 4468, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Broca, Service de Gériatrie, Paris, France. olivier.hanon@brc.aphp.fr.
authors: Olivier
authors: O
authors: Hanon
authors: Université Paris Descartes, Sorbonne Paris Cité, EA 4468, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Broca, Service de Gériatrie, Paris, France.
authors: Clemence
authors: C
authors: Boully
authors: Université Paris Descartes, Sorbonne Paris Cité, EA 4468, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Broca, Service de Gériatrie, Paris, France.
authors: Laure
authors: L
authors: Caillard
authors: Université Paris Descartes, Sorbonne Paris Cité, EA 4468, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Broca, Service de Gériatrie, Paris, France.
authors: Florian
authors: F
authors: Labourée
authors: Université Paris Descartes, Sorbonne Paris Cité, EA 4468, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Broca, Service de Gériatrie, Paris, France.
authors: Sophie
authors: S
authors: Cochiello
authors: Université Paris Descartes, Sorbonne Paris Cité, EA 4468, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Broca, Service de Gériatrie, Paris, France.
authors: Edouard
authors: E
authors: Chaussade
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000419:Albuminuria / Q000209:etiology; D017311:Amlodipine / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003692:Delayed-Action Preparations; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D004232:Diuretics / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D007190:Indapamide / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D017311:Amlodipine; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D003692:Delayed-Action Preparations; D004232:Diuretics; D004656:Enalapril; D007190:Indapamide
keywords: amlodipine; blood pressure; combination treatment; hypertension; indapamide SR.