Literature DB >> 28460784

The reduction in CVD outcomes with antihypertensives: A mandatory goal.

Rajeev Gupta1.   

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Year:  2017        PMID: 28460784      PMCID: PMC5414971          DOI: 10.1016/j.ihj.2017.02.011

Source DB:  PubMed          Journal:  Indian Heart J        ISSN: 0019-4832


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Dear Editor, I peruse with interest the timely editorial with immense clinical utility. Even though the large dedicated head-to-head comparison trials to assess hard cardiovascular (CVD) outcomes are missing (as hard to fund such trials), the indirect comparisons support indapamide better than chlorthalidone (CTZ) and CTZ better than hydrochlorothiazide (HCTZ), particularly in terms CVD outcomes. Beta blockers (BBs) and angiotensin receptor blockers (ABBs) despite reducing blood pressure failed to show definite superiority in CVD outcomes. Thus with any antihypertensive agent (new or old) reduction in hard outcomes assumes paramount importance: precisely why a largely asymptomatic condition is treated. In 1980, Multiple Risk Factor intervention Trial (MRFIT) policy advisory board changed the hypertension treatment protocol, recommending CTD over HCTZ for initial hypertensive therapy. This was done as coronary heart disease (CHD) mortality in special intervention group using HCTZ was 44% higher than other clinics using CTD (importantly drug was documented at each follow-up). This was the first study in the world to show differential mortality reduction between HCTZ and CTD. More than 35 years have lapsed, still we find commonly albeit inappropriately, HCTZ in combination with many drugs like ACEI/ARB/BB all over the globe, a serious mistake: in need of contemplation and correction. One more diuretic drug may be considered, irrespective of whichever thiazide diuretic is chosen: mineralocorticoid receptor antagonist (MRA) like spironolactone (12.5–25 mg/day), not only in resistant hypertension but for uncontrolled hypertension with reasonable renal function and normal potassium levels. In view of documented CVD outcome benefits, use of indapamide is strongly recommended not only for uncomplicated primary hypertension but also for hypertension complicated with other common comorbidities like diabetes mellitus, renal impairment of any degree (including patients on long-term maintenance hemodialysis), target organ damage like LVH, and in very old persons etc.

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2.  Clinical efficacy, safety, and pharmacokinetics of indapamide in renal impairment.

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Review 5.  Mineralocorticoid receptor antagonists: emerging roles in cardiovascular medicine.

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