Indapamide in the management of post-partum hypertension: a randomized, case-control study

Abstract

Background: Hypertensive disorders in pregnancy have been recognized as an important risk factor for cardiovascular disease in women. Therefore, lifestyle modifications, regular blood pressure control, and control of metabolic factors are recommended after delivery, to avoid complications in subsequent pregnancies and to reduce maternal cardiovascular risk in the future. There are no uniform recommendations for the treatment of post-partum hypertension yet. Methods and results: In a case-control, open-label 6-month study, 30 post-partum hypertensive women [aged 23-39 years; body mass index 26.2±4.4 (SD) kg/m2; 10 with previous pre-eclampsia, 10 pre-existing hypertension, 10 preexisting hypertension plus superimposed pre-eclampsia; 60% nursing mothers] were randomized 1:1 to receive either indapamide 1.5 mg daily or adjusted-dose methyldopa. No significant differences observed between the two groups at baseline. After comprehensive follow-up, blood pressure was not found to differ substantially between indapamide and methyldopa groups (113±6/74±4 mmHg vs. 116±5/75±4 mmHg respectively, p=NS). There was a significant difference in weight reduction, in favour of indapamide (-5.3 kg vs. -0.8 kg, p=0.0035), as well as in decrease of microalbuminuria (-153.6 mg/24 h vs. -24.5 mg/24 h, p=0.0005) and left ventricular mass index (-21.3 g/m2 vs. -8.4 g/m2 p=0.0051). No significant changes in lipid and glucose metabolism were found in both groups. Treatment with indapamide significantly improved endothelial function, non-invasively assessed by flow-mediated dilatation of the brachial artery using high-resolution ultrasound (+7.8% vs. +2.1%, p=0.035). Moreover, indapamide demonstrated good safety profile and led to high adherence to treatment. In the two groups, no reduced milk production was observed. Conclusions: This study provides the first evidence that indapamide is a well tolerated and effective treatment for post-partum hypertension and it should be beneficial for cardiovascular prevention in such patients. The clinical implications of indapamide for post-partum and postpreeclamtic hypertensive women need to be conformed in large-scale clinical outcome trials.