Sustained-release indapamide in the treatment of arterial hypertension: monotherapy and fixed-dose combinations

The aim of the review to systematise recently published data from clinical trials and updated clinical guidelines on the use of sustained-release indapamide (SR 1.5 mg) as monotherapy and as a part of fixed-dose combinations in the treatment of arterial hypertension, with a focus on populations at high cardiovascular and cardiometabolic risk and on the role of triple-combination regimens in patients not achieving target blood pressure. Arterial hypertension remains one of the leading risk factors for cardiovascular complications and premature mortality, with persistent inadequate blood pressure control even among patients receiving antihypertensive therapy. Both Russian and European 2024 clinical guidelines emphasize early initiation of combination therapy, preferably as fixed-dose combinations, and timely intensification with a transition to a triple-combination regimen in patients not achieving target within 1-3 months. The review discusses the clinical positioning of indapamide SR 1.5 mg, its pharmacokinetic properties, metabolic neutrality, and organ-protective effects, including regression of left ventricular hypertrophy and nephroprotection. Data from major international trials (HYVET, ADVANCE, LIVE, NESTOR) and Russian studies of the fixed triple combination lisinopril/amlodipine/ indapamide in patients with high-risk hypertension are analysed. Sustained-release indapamide occupies an important place in the modern treatment strategy for arterial hypertension due to high antihypertensive efficacy, metabolic neutrality, proven organ-protective potential, and the availability of hard-endpoint outcome trials. Inclusion of indapamide SR in dual and fixed triple combinations with a renin-angiotensin-aldosterone system blocker and a calcium channel blocker allows faster achievement of target blood pressure and improves treatment adherence in high-risk patients.