To evaluate the long-term antihypertensive efficacy and safety of indapamide SR/amlodipine in ≥65 year olds, in the randomized, double-blind, 1-year NESTOR study.
The NESTOR study included 570 hypertensive (aged 35-80 years, systolic blood pressure [SBP] 140-180 and diastolic blood pressure [DBP] <110mmHg), diabetic patients with microalbuminuria, 187 of whom were aged ≥65 years. Antihypertensive therapy was stopped before inclusion and indapamide SR 1.5mg or enalapril 10mg administered. If target BP (<140/90mmHg) was not achieved at 6 weeks, amlodipine 5mg was added with uptitration to 10mg if needed. Follow-up period was 52 weeks.
At 52 weeks in 107 patients aged ≥65 years receiving bitherapy, SBP/DBP decreased significantly (P<0.001) from baseline by 30±12/ 14±9mmHg with indapamide SR/amlodipine (n=53) vs 22±16/11±9mmHg with enalapril/amlodipine (n=54). There was a significantly greater SBP reduction of 6.2±2.7mmHg (P=0.02, adjusted on baseline) with indapamide SR/amlodipine vs enalapril/amlodipine, a larger difference than that seen in all ages on bitherapy (4.1±1.5mmHg; P=0.006). Moreover, BP response rate (<140/90mmHg or decrease of 20mmHg in SBP or 10mmHg in DBP) in ≥65 year olds was greater with indapamide SR/ amlodipine (88%) than with enalapril/amlodipine (75%). Indapamide SR and amlodipine were associated with a good safety profile. Three patients in each group discontinued treatment.
This analysis confirms that a thiazide-like diuretic/CCB combination (indapamide SR/amlodipine) more effectively lowers SBP than an angiotensin-converting enzyme inhibitor/CCB combination in these hypertensive patients aged ≥65 years, whilst maintaining a good safety profile.