The effect of indapamide vs. bendroflumethiazide for primary hypertension: a systematic review

Tatiana Macfarlane (Lead / Corresponding author), Filippo Pigazzani, Robert Flynn, Thomas MacDonald

    Research output: Contribution to journalReview articlepeer-review

    9 Citations (Scopus)
    283 Downloads (Pure)

    Abstract

    The aims of the current review were to compare the efficacy of monotherapy with bendroflumethiazide vs. indapamide on mortality, cardiovascular outcomes, blood pressure, need for intensification of treatment and treatment withdrawal. Two authors independently screened the results of a literature search, assessed the risk of bias and extracted relevant data. Randomized clinical trials of hypertensive patients of at least a 1-year duration were included. When there was disagreement, a third reviewer was consulted. Risk ratio (RR) and mean differences were used as measures of effect. Two trials comparing bendroflumethiazide against placebo, one comparing indapamide with placebo and three of short duration directly comparing indapamide and Bendroflumethiazide, were included. No statistically significant difference was found between indapamide and bendroflumethiazide for all deaths [RR 0.82; 95% confidence interval (CI) 0.57, 1.18], cardiovascular deaths (RR 0.82; 95% CI 0.55, 1.20), noncardiovascular deaths (0.81; 95% CI 0.54, 1.22), coronary events (RR 0.73; 95% CI 0.30, 1.79) or all cardiovascular events (RR 0.89; 95% CI 0.67, 1.18). Indapamide performed worse for stroke (RR 2.21; 95% CI 1.19, 4.11), even though a reduction in RR compared with placebo was observed in both groups. There was no statistically or clinically significant difference between indapamide and bendroflumethiazide in blood pressure reduction (mean absolute difference <1 mmHg). The present review highlights a lack of studies to answer the review question but also a lack of evidence of superiority of one drug over the other. Therefore, there is a clear need for new studies directly comparing the effect of these drugs on the outcomes of interest.

    Original languageEnglish
    Pages (from-to)285-303
    Number of pages19
    JournalBritish Journal of Clinical Pharmacology
    Volume85
    Issue number2
    Early online date12 Oct 2018
    DOIs
    Publication statusPublished - 1 Feb 2019

    Keywords

    • bendroflumethiazide
    • cardiovascular
    • hypertension
    • indapamide
    • mortality
    • systematic review
    • thiazide diuretics

    ASJC Scopus subject areas

    • Pharmacology
    • Pharmacology (medical)

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