Comparison of the Effects of Diuretics on Blood Pressure and Arterial Stiffness in Patients With Stroke

Objectives

Indapamide (IND) and bendroflumethiazide (BDZ) are both widely used in patients with stroke. We compared their effects on arterial blood pressure (BP) and arterial stiffness in a group of patients with stroke.

Methods

In a prospective, randomized, double-blinded study we investigated the effect of 28-day treatment with BDZ (2.5 mg once daily) or IND (2.5 mg once daily) on BP and arterial stiffness in a group of patients with first-ever ischemic stroke.

Results

All data are expressed as mean (SD). In all, 23 patients completed the protocol (age 70.0 ± 9.55 years). Group I (IND) and group B (BDZ) comprised 13 and 10 patients, respectively. Groups were well matched for demographics and baseline characteristics. Mean arterial pressure reduction from baseline was I = 14.3 ± 10.3 mm Hg (P < .001) versus B = 9.1 ± 11.2 mm Hg (P = .03). Augmentation index (AI) was reduced by: I = 4.94 ± 7.22% (P = .037) versus B = 6.17 ± 7.85% (P = .035). Time to reflection was increased by I = 3.22 ± 9.57 milliseconds (P = .268) versus B = 4.71 ± 5.30 milliseconds (P = .020). There was no significant difference between the two drugs with regard to change in BP or arterial stiffness. Pooled data showed a reduction in mean arterial pressure by 12.1 ± 10.77 mm Hg (P < .0001) and in AI by 5.5 ± 7.36% (P = .002), and a small increase in time to reflection by 3.9 ± 7.79 milliseconds (P = .029). The change in BP explained up to 28% of the change in AI.

Conclusion

Both diuretics altered hemodynamic parameters to a similar extent. The results are consistent with a direct effect of diuretic therapy on vascular function. The influence of both diuretics on arterial stiffness was similar.

Key Words: Word arterial stiffness, diuretics, stroke