Current Medical Research and Opinion® 0300-7995

Vol. 23, No. 12, 2007, 2929–2936 doi:10.1185/030079907X242674

© 2007 LibraPharm Limited All rights reserved: reproduction in whole or part not permitted

ORIGINAL ARTICLE

Antihypertensive efficacy of
indapamide SR in hypertensive
patients uncontrolled with a
background therapy: the NATIVE
study*
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J. Akram a, U. E. Sheikh a, M. Mahmood a and R. Donnelly b

a 
Medicine and Cardiology Dept, King Edward Medical College, Lahore
54660 Pakistan
0 7
b  0
2 Trust.
University of Nottingham and Derby Hospitals NHS Foundation
Uttoxeter Road, Derby DE22 3DT, UK

Address for correspondence:  Professor Richard Donnelly, University of Nottingham Medical School,
Derby City General Hospital, Uttoxeter Road, Derby DE22 3DT, UK. Tel.: +44 (1332) 724618;
For personal use only.

Fax: +44 (1332) 724 619; richard.donnelly@nottingham.ac.uk
Key words:  Antihypertensive drugs – Indapamide sustained release – South Asian population –
Uncontrolled hypertension

ABSTRACT

Objectives: Antihypertensive monotherapy rarely
achieves blood pressure (BP) control. NATIVE
(NATrilix SR use in combInation antihypertensiVe
thErapy) evaluated indapamide sustained release
(SR) in hypertensive patients receiving background
therapy.
Research design and methods: Patients
remaining hypertensive (systolic BP [SBP], 145–
180 mmHg; diastolic BP [DBP], 95–105 mmHg)
while receiving an angiotensin-converting
enzyme (ACE) inhibitor (n = 709), β-blocker (n =
629), calcium-channel blocker (CCB; n = 493),
angiotensin II type 1 receptor blocker (ARB; n =
75), α-blocker (n = 29) or other therapy (n = 6)
were enrolled, recruited by physicians from 228
centres in Pakistan. Indapamide SR 1.5 mg was
administered daily for 3 months with background
therapy. BP was assessed every 2 weeks, and
blood glucose and total cholesterol were evaluated
at baseline and study end in a patient subgroup.
Adverse events were also recorded.
Main outcome measures and results: Of
2073 enrolled patients (49% males; mean age
51 years), 1941 received indapamide SR and
background therapy. SBP and DBP decreased
significantly (SBP, 166 ± 16 mmHg at baseline
vs. 132 ± 12 mmHg at 3 months; DBP, 102 ±
8 mmHg vs. 83 ± 6 mmHg; both p < 0.0001
vs. baseline). Patients uncontrolled with an
ACE inhibitor, β-blocker, CCB or ARB achieved
an SBP/DBP decrease of 34 ± 15/19 ± 9,
33 ± 17/19 ± 10, 33 ± 15/18 ± 8 or 35 ±
16/20 ± 12 mmHg, respectively (all p <
0.0001). In all, 84% of patients achieved target
SBP (≤ 140 mmHg) and 61% achieved BP
normalisation (SBP < 140, DBP < 90 mmHg).
The absence of placebo control may lead to an
overestimation of the extent of the BP reduction
achieved. Glucose and cholesterol levels were
unaffected by indapamide SR. Four percent of
patients experienced side-effects, which were
mild-to-moderate in severity.
Conclusions: In patients with hypertension
despite antihypertensive therapy, indapamide SR
significantly reduced BP with a good acceptability
profile. Indapamide SR may represent an effective
additional therapy for patients who do not achieve
BP goals with other antihypertensive agents.

* Data reported here were previously presented as an abstract at the European Society of Hypertension (ESH),
16th European Meeting on Hypertension, Madrid, 12–15 June 2006

Paper 4135 2929

 Introduction
High blood pressure (BP) remains a major public
health concern due to the well-recognised relationship
between BP and risks of cardiovascular disease. Indeed,
high BP has been highlighted as one of the most
important preventable causes of premature morbidity
and mortality in developed and developing countries1.
Guidelines recommend 140/90 mmHg as a target BP in
the majority of patients2–4. However, in daily practice
most patients have difficulty achieving these targets
with a single agent5–6. Furthermore, in populations at
higher cardiovascular risk, such as those with diabetes,
mono­therapy is even less likely to achieve the more
stringent targets specified for these populations. In one
survey of hypertensive patients with type 2 diabetes,
37.1% were receiving monotherapy and only 3% of
these reached the guideline target of 130/85 mmHg7.
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Despite the clear limitations of monotherapy, evidence
suggests that the majority of patients will continue
to receive single-agent antihypertensive treatment8–11
and thus remain at elevated risk of cardiovascular
complications. The use of combination therapy,
employing antihyper­t ensive agents from different
pharmacological classes, is one approach to increasing
the likelihood of optimal BP control12–14.
For personal use only.
Diuretics are considered a cornerstone of anti­hyper­
tensive therapy and various guidelines recommend their
use as part of an effective approach to the management
of hypertension2–4. Indapamide sustained release (SR)
(Natrilix*) is a thiazide-type diuretic that has been
shown to be an effective antihypertensive agent when
administered as a monotherapy15. Given in a low-dose
formulation, indapamide SR has shown equal efficacy
to higher doses of the drug, whilst minimising the
incidences of adverse events16. However, no data are
available concerning the use of this drug in combination
therapy strategies.
The multicentre, community-based NATIVE
(NATrilix SR use in combInation antihypertensiVe
thErapy) study was undertaken to evaluate the benefits
of indapamide SR in hypertensive patients whose BP was
uncontrolled on background antihypertensive therapy
that did not include diuretics. This pragmatic study
was performed in routine daily practice to evaluate the
benefits of this approach in the clinical setting.
Patients and methods
Study design
This was a community-based, open-label, 3-month
observational study involving hypertensive patients
* Natrilix is a registered trade mark of Servier, Neuilly-Sur-Seine, France
2930  Antihypertensive efficacy of indapamide SR in NATIVE © 2007 LIBRAPHARM LTD – Curr Med Res 2007; 23(12)
recruited by physicians from 228 centres in Pakistan.
At inclusion, baseline systolic BP (SBP) and diastolic
BP (DBP) were measured and antihypertensive therapy
was recorded. Indapamide SR 1.5  mg once daily was
added to existing antihypertensive monotherapy, which
then remained unchanged for the duration of the study.
Subsequent assessments were performed at fortnightly
intervals, at which time SBP, DBP and antihypertensive
therapy were recorded. As part of the safety evaluation,
heart rate, blood glucose and serum total cholesterol were
measured at the beginning and end of the study in a group
of randomly selected patients. The study was performed
in accordance with Good Clinical Practice and approved
by the appropriate ethics committees. Each patient gave
his/her written informed consent before enrolment.
Study population
Male or female patients aged 18 years or older with
mild-to-moderate hypertension that was uncontrolled
on background antihypertensive therapy were eligible
for inclusion. Uncontrolled hypertension was defined
as SBP 145–180  mmHg and DBP 95–105  mmHg on
two separate occasions. Patients receiving diuretics
or diuretic-based regimens, or with hypertension due
to a known secondary cause, were not eligible for
the study. Other reasons for patient exclusion were:
history of stroke; myocardial infarction or coronary
artery bypass surgery within the previous 3 months;
continued treatment with any agent known to alter
arterial BP; severe cardiac disease; accelerated or
malignant hypertension or optic fundus changes
greater than grade 2; significant hepatic dysfunction
or renal insufficiency (creatinine >   2  mg/dL); severe
concomitant pathology; known hypersensitivity to
study drugs; use of lithium or non-antiarrhythmic
drugs; clinically relevant abnormal laboratory values
(including hypokalaemia); patients deemed unwilling
or unable to abide by protocol requirements; patients
taking an investigational drug within 30 days prior to
enrolment; patients known to be abusing alcohol and/
or other drugs; and pregnant or breast-feeding women.
Efficacy evaluations
The main efficacy endpoint was the decrease in SBP
and DBP. Secondary criteria were normalisation of BP
(determined as SBP < 140 mmHg and DBP < 90 mmHg,
as per the recommendations of international
guidelines 3) and achievement of the SBP target of
≤ 140 mmHg (130 mmHg for diabetic patients). Supine
SBP and DBP measurements were obtained with a
mercury sphygmo­manometer from the same arm and
 by the same investigator at entry to the study and at
each following assessment. BP was measured after 3
minutes of rest and the mean of three measurements
performed at 1-minute intervals was recorded.
Acceptability evaluations
The intensity, onset, and duration of all adverse events
occurring during the study were recorded, as was the
potential for a causal relationship with indapamide SR
therapy.
Laboratory investigations
Blood samples from randomly selected patients were
taken to a central testing laboratory and analysed for
fasting blood glucose and serum total cholesterol.
Fasting blood glucose was determined by the GOD–
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population and in relation to the use of specific
background therapies were evaluated with Student’s
t-test (alpha = 5%) using SPSS software. The influence
of diabetic status (yes/no) on the change in BP was also
evaluated. Changes in glucose and cholesterol levels
from baseline to endpoint were also evaluated using
Student’s t-test.
Results
Patient demographics and baseline
characteristics
A total of 2073 patients were enrolled in the study, of
whom 49% were males. Hypertension had been present
for an average of 5.2 years in the study population.
Background therapy and active treatment were received
throughout the study by 1941 patients; outcome data

PAP method using an analysis system from Merck
KGaA (Darmstadt, Germany). Serum total cholesterol
was determined quantitatively by the CHOD–PAP
method using an analysis system from Merck KGaA.
Statistical analyses
BP data are presented as mean BP ± standard deviation.
For personal use only.
were missing for the remaining 132 patients. Of the
1941 patients who received background antihypertensive
therapy, 709 received an angiotensin-converting enzyme
(ACE) inhibitor, 629 a β-blocker, 493 a calcium-
channel blocker (CCB), and 75 an angiotensin II type 1
receptor blocker (ARB). Demographic and baseline
characteristics are presented in Table 1.
Of the 286 patients who were reported to have

Changes in BP from baseline to endpoint in the overall concomitant illnesses, 193 had type  2 diabetes

Table 1.  Demographics and baseline characteristics for the NATIVE (NATrilix SR use in combInation antihypertensiVe
thErapy) study (N = 2073)

Parameter Baseline value

Males, n (%) 1005 (49)
Females, n (%) 1068 (51)
Age, years (mean, range) 50.8 (23–86)
Weight, kg (mean, range) 70.0 (40–118)
Height, cm (mean, range) 161.8 (116–202.5)
Body mass index (kg/m²) 26.9 (13.9-48.6)
Systolic blood pressure, mmHg (mean, SD) 165.6 (16.2)
Diastolic blood pressure, mmHg (mean, SD) 101.8 (8.6)
Current therapy, n (%)
Angiotensin-converting enzyme inhibitors 709 (36.5)
β-Blockers 629 (32.4)
Calcium-channel blockers 493 (25.4)
Angiotensin II type 1 receptor blockers 75 (3.9)
α-Blockers 29 (1.5)
Other 6 (0.3)
Data available 1941 (100)
Patients with diabetes (%)
Type 1 1 (0.1)
Type 2 193 (9.9)
Blood glucose, mg/dL (mean, SD) 131.8 (48.1)
Total cholesterol, mg/dL (mean, SD) 192.9 (35.7)

© 2007 LIBRAPHARM LTD – Curr Med Res 2007; 23(12) Antihypertensive efficacy of indapamide SR in NATIVE  Akram et al.  2931
 (10%). In this subgroup, 82 patients (43%) received
background therapy with an ACE inhibitor, 42 (22%)
a β-blocker, 47 (24%) a CCB, and 14 (7%) an ARB.
Approximately 12% (n = 243) of the overall population
were elderly (defined as >  65 years of age), of whom
59% were male. Of these, 90 patients (37%) received
background therapy with an ACE inhibitor, 64 (26%) a
β-blocker, 64 a CCB (26%), and 8 (3%) an ARB.
Amongst the 1941 patients with available data
concerning specific background therapies, atenolol (n =
534, 28%), amlodipine (n = 345, 18%), and enalapril
(n = 289, 15%) were the most commonly prescribed
agents in the overall population and in the diabetic and
elderly subgroups.
Blood pressure
Both SBP and DBP decreased following the addition
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35 ± 16/20 ± 12  mmHg, for SBP/DBP respectively,
following 3-month treatment with indapamide SR (all
p < 0.0001 vs. baseline).
In patients with diabetes, both SBP and DBP
decreased following the initiation of indapamide SR
therapy; BP reductions were similar to those observed
in the overall population (Figure 2). From baseline to
study end, SBP fell by 35 ± 16 mmHg from 168 ± 15
to 132 ± 11  mmHg and DBP fell by 18 ± 11  mmHg
from 101 ± 9 to 84 ± 7  mmHg (both p < 0.0001 vs.
baseline) (Figure  2). Overall, 59% of patients with
diabetes achieved target SBP (≤ 130 mmHg), with 44%
achieving normalisation (SBP ≤  130  mmHg and DBP
≤ 80 mmHg).
In elderly patients, the same range of BP reductions
was observed after initiation of the treatment with
indapamide SR. From baseline to study end, SBP fell
by 36 ± 18 mmHg from 171 ± 17 to 135 ± 11 mmHg

of indapamide  SR to background antihypertensive
therapy (Figure 1). From baseline to 3 months, SBP
decreased by 33 ± 16 mmHg from 166 ± 16 mmHg to
132 ± 12  mmHg, and DBP by 19 ± 10  mmHg from
102 ± 9 mmHg to 83 ± 6 mmHg (both p < 0.0001 vs.
baseline) in the overall population. Mean reductions
in BP were similar irrespective of background therapy
(Figure 1). Overall, 84% of patients achieved target SBP
For personal use only.
and DBP fell by 19 ± 11 mmHg from 103 ± 10 to 84 ±
6  mmHg (both p < 0.0001 vs. baseline) (Figure 2).
Overall, 79% of elderly patients achieved target SBP
(≤ 140 mmHg), with 50% achieving normalisation (SBP
< 140 mmHg and DBP < 90 mmHg).
In the subgroup of patients receiving background
amlodipine (n  = 345), SBP fell by 33  ± 15   mmHg
from 165 ± 15  mmHg to 133 ± 11  mmHg and DBP

(≤ 140 mmHg), with 61% of patients achieving normal­
isation (SBP <   140   mmHg and DBP <   90   mmHg).
Similarly, analysis of patients grouped according to
uncontrolled therapy with an ACE inhibitor, β-blocker,
CCB, or ARB showed decreases to mean levels by
34 ± 15/19 ± 9, 33 ± 17/19 ± 10, 33 ± 15/18 ± 8 and
fell by 18  ± 8   mmHg from 101  ± 7  mmHg to 84  ±
6 mmHg at study end (both p < 0.0001 vs. baseline).
Similar BP reductions were observed in patients
receiving background amlodipine as in the overall,
diabetic, and elderly patient groups (Figure  2).
Overall, 84% of patients receiving indapamide SR and

Figure 1.  Systolic and diastolic blood pressure at baseline and study end in hypertensive patients who received
indapamide SR in addition to background antihypertensive therapy for 3 months. Data are presented according to
background therapy

2932  Antihypertensive efficacy of indapamide SR in NATIVE © 2007 LIBRAPHARM LTD – Curr Med Res 2007; 23(12)
 amlodipine achieved target SBP, with 61% achieving
normalisation.
Laboratory evaluations
Laboratory values were assessed in a subgroup of
1361 patients for glucose control and 1344 patients
for cholesterol values. Following the addition of
indapamide SR to the background antihypertensive
regimen, there were slight reductions in both random
blood glucose and total cholesterol values (mean
decreases of 5.7 mg/dL and 9.8 mg/dL, respectively)
in the overall population. Comparative changes in
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For personal use only.
blood glucose and total cholesterol for the overall,
diabetic and elderly patient populations are shown in
Figure 3.
Acceptability
A total of 46 patients discontinued the study early.
The most common reason for discontinuation was
adverse events (n = 31), with other reasons including
pregnancy, myocardial infarction, cerebrovascular
accident, and ischaemic heart disease. Safety data were
available for 1795 patients, of whom 72 patients (4.0%)
experienced side-effects. Side-effects were mild-to-

Figure 2.  Mean blood pressure at baseline and 3 months (study end) in the overall patient population and in the
diabetic and elderly patient subpopulations

Figure 3.  Evolution of metabolic parameters during the study in the overall patient population and in the diabetic and
elderly patient subpopulations

© 2007 LIBRAPHARM LTD – Curr Med Res 2007; 23(12) Antihypertensive efficacy of indapamide SR in NATIVE  Akram et al.  2933
 moderate in severity and included fatigue, headache,
cramps, and constipation.
Discussion
This study showed that in patients with uncontrolled
hypertension, indapamide SR significantly reduced BP,
independently of background therapy, and enabled
target SBP to be achieved in most patients with good
acceptability.
The magnitude of the BP reduction achieved with
indapamide SR in the present study remained consistent
irrespective of the background antihypertensive
therapy that was being administered. Beyond the
direct effects of indapamide SR on blood vessels and
blood volume, this benefit is thought to originate from
the pharmacological synergy that can be achieved
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by combining a diuretic with an agent from another
therapeutic class and is supported by clinical study
data4,17.
It is well-recognised that antihypertensive mono­
therapy is frequently ineffective for achieving target
BP. One study has reported that monotherapy provides
BP control in no more than 40% of patients5. Baseline
data from the present study involving patients who
For personal use only.
remained hypertensive while receiving background
therapy highlight the limitations of monotherapy.
In these patients, baseline BP was elevated above
target levels regardless of the antihypertensive agent
employed.
Indapamide SR is a thiazide-type diuretic antihyper­
tensive agent that is effective at decreasing BP18–21 and
has been shown to confer beneficial effects on other
surrogate markers of cardiovascular risk, such as left
ventricular mass index 22 and microalbuminuria 23.
Current guidelines recommend thiazide-type diuretics,
such as indapamide SR, as the preferred initial therapy
for patients with hypertension2. This study illustrates
that there are also substantial benefits to be obtained
from adding indapamide SR to antihypertensive agents
from other classes, enabling normalisation of target BP
to be achieved in the majority of patients (61%).
The use of some diuretic agents has been associated
with an increased risk of new-onset diabetes in the
long term 24. The lack of significant alterations in
blood glucose or cholesterol levels seen in the overall
population in this study supports the previously
reported metabolic neutrality of indapamide SR18,25.
Of particular note is the substantial SBP reduction
achieved in patients with diabetes in the study (mean
SBP reduction 35 mmHg), such that levels approached
those recom­mended by international guidelines, even
when considering the lower SBP and DBP targets
recommended for these patients.
2934  Antihypertensive efficacy of indapamide SR in NATIVE © 2007 LIBRAPHARM LTD – Curr Med Res 2007; 23(12)
Control of hypertension in elderly patients, who often
suffer from comorbid illnesses, presents a challenge to
clinicians. Optimal management should involve drugs
with minimal or no side-effects due to the potential
for modified risk/benefit profiles in the elderly as a
result of altered metabolism and exaggerated drug
sensitivity 26. In this study, 79% of elderly patients
receiving indapamide SR achieved target SBP (mean
SBP reduction 36  mmHg) and similar reductions in
BP, blood glucose, and total cholesterol were observed
compared with the overall population.
Four percent of patients experienced side-effects
in this study, all of which were mild-to-moderate in
intensity. This outcome corroborates the drop-out rates
observed in long-term trials with indapamide SR used in
monotherapy20,22. As a reduction of 10 mmHg SBP may
lead to an average reduction of 25% in cardiovascular
mortality, the benefits of the SBP reduction by 33 mmHg
observed in the current study largely overcome the risk
of side-effects27. The good tolerability profile and low
incidence of adverse events associated with indapamide SR
in this study suggest that, when administered as part of
combination antihypertensive treatment, this agent may
be associated with improved patient compliance.
This study was performed using a pragmatic,
community-based approach. However, limitations
associated with certain aspects of the study design
must be acknowledged. There was no placebo control,
thus the analysis may overestimate the extent of the BP
reduction achieved with indapamide SR and present a
positive bias towards the study outcome. Regarding
acceptability analysis, data from only 1795 of the 2073
patients were available. Due to the lack of data on
patients’ potassium levels throughout the study, a full
safety analysis cannot be performed, thus limiting the
conclusions that can be drawn with regards to the safety
and tolerability of indapamide SR. These limitations
should be taken into account when drawing conclusions
from the data presented in this manuscript.
This trial was conducted in Pakistan and affords new
data among a population for which little information
is available 28. The combination therapy approach
employed in the current study is recommended by
international guidelines and represents a rational
strategy to decrease end-organ damage and reduce
the risk of cardiovascular events. Such an approach is
associated with a greater likelihood of achieving both
target BP and fewer side-effects, the latter due to
lower-dose combinations2. The current results, derived
from a community-based setting, are likely to resemble
closely the benefits that can be anticipated in everyday
clinical practice and suggest the efficacy, safety, and
tolerability of indapamide  SR when administered
in addition to background therapy to patients with
previously uncontrolled hypertension.
 Conclusion
In patients with uncontrolled hypertension despite
background antihypertensive therapy, concomitant
administration of indapamide SR was associated with a
significant reduction in BP and allowed target BP to be
achieved in the majority of patients in an observational,
community-based study. Indapamide SR should be
considered as a safe and effective add-on therapy for
patients who do not achieve optimal BP targets with
other classes of antihypertensive agent.
Acknowledgements
Declaration of interest: NATIVE is an investigator-
initiated study sponsored by Servier Laboratories. The
authors also acknowledge the editorial assistance of
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Caroline Long in preparing the manuscript.
The following clinicians are thanked for their
participation in this study. From Bahawalpur: Abdul
Rauf, Ashraf Ali, Tariq Mahmood Ansari. From
Charsadda: Dr Younas. From Faisalabad: Abdul Ghafoor
Sajid Ansari, Abdul Wasim Khan, Ashfaq Ahmad, Asif
Khan Ghouri, Ghulam Sarwer, Hafiz Rashid Mehmood,
Ijaz Anwar, Khalid Ismail, Masood Ahmad, Mehboob
For personal use only.
Elahi, M Islam, M Sharif, MS Qureshi, M Yasin, Nasir
Ahmad Nagra, Obaid Anwar Khan, Shabber Ahmed,
Shahzad Riaz, Waseem Tariq. From Gujranwala: Arshid
Javid, Ashraf Raza, Fazal Mehmood, Fazal ur Rehman,
Khalid Javed, Mushtaq Hussain Sabir, Nawaz Ghuman,
Sadat Hussain, Shaukat Ali, Shehzad Saleem, Zafar
Qureshi, Zaheer ch Iqbal. From Hyderabad: Abid KK
Abid, Ali Ghohar Abra, Anis Sakrani Shaukat, Ashok
Kumar, Farooq Ahmed, Hanif Khattri, Haroon Shaikh,
Iqbal Haroon Memon, Irshad Ahmed, Jawad Sakrani,
Khalid Abro, Captain Khauja, Majeed Chundrighar,
Mohammad Idris Bawani, Mohan Ial Bhootrani, M
Rafique Khilji, Muhammad Ali Memon, Nadeem
Anwar, Nausrat Hussain, Rano Mal, Rafiq A Khalid,
Rauf Memon, Saleem Madrasswala, Shaikh Ajaiz, Zia
ud din Hashmi, Usman Haroon. From Karachi: Abid
Hussain, Abu Muzzaffar, Ahmad Madni, Ali Hussain,
Altaf Hussain, Anwar Aelam, Ashraf Mossani, Ashraf
Rahim, Aslam Shah, Captain Arshad, Farooq Ismil
Suriya, GM Bhatti, Hanif Bikya, Hanif Gaba, Hanif
Memon, Iqbal Batawia, Iqbal Edhi, Khalid Farooqi, M
Jahangir, Muhammad Ageel Rai, Nadeem Qureshi,
Naeem Afzal, Najam Mehmoodi, Payyam ud Din, Rafi
I Mugha, Rashid Jamil, Riaz Ali Shah, Saeed A Abbasi,
Saeed Ullah, Saijad Haider, Shamim Saith, Shariat Ullah
Siddiqui, Shaukat Ali, Shiraz Talibi, Shirin Shah Buddin,
Shohab Masroor, SM Tariq Shah, S Musharraf Ali, Sohail
Rangwala, Waseem Shareef, Yousaf Sheikh, Dr Zara.
From Lahore: Abdur Rehman, Anees ur Rehman, Anjum
© 2007 LIBRAPHARM LTD – Curr Med Res 2007; 23(12) Antihypertensive efficacy of indapamide SR in NATIVE  Akram et al.  2935
Raza Mumtaz, Ashfaq Rana, Asif Ijaz Minhas, Asif Rana,
Basat Zaheer Malik, Bashir Ahmad Qamar, Ebrahim
Yousaf, Farooq Hameed, Farooq Sadiq, Hamayun
Rasheed, Irshad Tariq, Khalid Mehmood, Khan Bahadur
Nayyar, Ljaz Sadiq Kahloon, Major Ikram Shahid,
Mazhar ul Islam, M Iqbal Chaudhary, Manzoor Rana,
M Khursid, M Sohail, Muhammad Arshad, Muhammad
Azam Khan, Muhammad Ishfaq, Muhammad Saeed,
Muhammad Saleem, Naeem Sheikh, Naveed Khalid,
Qaiser Malik, Sajjaid Ahmed Malik, Shaharyar Ahmad
Bhatti, Tahir Aman, Tahir Bashir, Tariq Javaid, Toheed
Qammer, Warris Sheikh, Zafar Iqbal Bhatti. From
Mardan: Dr Jahangir, Sharif Gul. From Multan: Amir
Nawaz, Arshad Qurashi, Azhar Waheed, Faheem Javed,
Faiz Athar Khan, Hafiz Qamar Munir, Hussain Malik,
Kaleem Abbas Zaidi, Mehmood Khawja, M Sadar Khan,
Muhammad Abid, Muhammad Shakeel Amjad, M Zafar
Iqbal Chaudhary, Saeed Ahmad, Saleem Akhtar, Shahid
Rafique, Zaheer Abbas, Zahid Iqbal. From Nowshera:
Abdul Rashid Tajik, Murad Ali. From Pabi: Tariq
Khan. From Peshawar: Abid Muneer, A Qadus Asim,
Aziz ud din Khattak, GM Butt, Inam Ullah Qadri, M
Anwar, Mehmood Sultan Paracha, Muhammad Aslam,
Muhammad Haroon, Muhammad Shafiq, Riaz Shahid,
Saeed ul Majeed, Tariq Siddique. From Quetta: Arif
Tabba, Ashok Kumar, Ghulam Dastageer, Hamid Bashir,
Muhammad Iqbal, Muhammad Iqbal Kasi, Muhammad
Jumma. From Rawalpindi: Abdullah Jan, Abdul Karim
Khan, Adalat Khan, Asif Sallah ud Din, Athar Rasheed,
Ayaz Saeed, Ehsan ul Haq, Farooq Sheikh, Irfan Tahir,
Israr ul Haq, Khalid Rasheed, M Afzaal Qureshi,
Mansoor Jamal, M Humayun, Muhammad Ahmad,
Muhammad Azam, Nazir Ahmad, Perviz Alam Qureshi,
SA Haider, Saijad Minhas, Sheikh, Shahzad Tahir, Syed
Usman Ahmad, Tanveer Ahmad, Zahir Ahmad. From
Sargodha: Iftab Jahangir, Irfan Farid, M Ikram Malik,
Muhammad Younis, Nazar Malik, Shehbaz Qureshi,
Zafar Latif Awan. From Sukkur: A Aziz Kotwal, Anwar
Ahmed Ansari, Atama Ram, Faroqh ul Islam Farooqui,
Ghavas ul Shan Khan, Hazoor Bux Tunio, Hira Nand
M Chawla, Khalid Iqbal Shamsi, M Hafeez Mughal,
Mukhtar Ahmad Sahto, M Zafar Jatoi, Raj Kumar T
Duseja, Shabir Ahmad Memon.
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Paper CMRO-4135_4, Accepted for publication: 24 September 2007
Published Online: 10 October 2007
doi:10.1185/030079907X242674

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