Blood pressure–lowering efficacy of indapamide SR/amlodipine combination in older patients with hypertension: A post hoc analysis of the NESTOR trial (Natrilix SR vs Enalapril in Hypertensive Type 2 Diabetics With Microalbuminuria)

To examine the antihypertensive efficacy and safety of indapamidesustained-release (SR)/ amlodipinecompared with enalapril/ amlodipinein patients 65 years and older with uncontrolled blood pressure (BP) on monotherapy, a post hoc analysisof the NESTOR trial (Natrilix SR vs Enalaprilin Hypertensive Type 2 Diabetics With Microalbuminuria) was conducted. NESTOR randomized 570 patients (n=197, aged ≥65 years) with hypertension (systolic BP 140–180/diastolic BP <110 mm Hg) to indapamideSR 1.5 mg or enalapril10 mg. If target BP (<140/85 mm Hg) was not achieved at 6 weeks, amlodipine5 mg was added with uptitration to 10 mg if required. A total of 107 patients aged 65 years and older received dual therapy (53 indapamideSR/ amlodipineand 54 enalapril/ amlodipine). Amlodipineuptitration occurred in 22 and 24 patients, respectively. At 52 weeks, mean systolic BP (±SE) reduction was significantly greater with indapamideSR/ amlodipinevs enalapril/ amlodipine6.2±2.7 mm Hg (P=.02). IndapamideSR/ amlodipinewas also associated with a greater BP response rate (88% vs 75%, respectively). Both regimens were well tolerated. IndapamideSR/ amlodipinemay be more effective than enalapril/ amlodipinefor lowering systolic BP in patients with hypertension aged 65 years and older.