Indapamide: the diuretic of choice for managing blood pressure in Indian populations

Janakiraman Ezhilan; P. R. Vaidyanathan; Rajasekar Nagarajan; Hari Om Tyagi; Akhil Kumar Sharma; Rajeev Garg; Puppanna Mallesh; Hiren Prajapati; Ankita Waghmare

doi:10.18203/2349-3933.ijam20253361

Authors

Janakiraman Ezhilan Department of Cardiology, Madras Medical Mission, Chennai, Tamil Nadu, India
P. R. Vaidyanathan Department of Cardiology, Hindustan Hospital, Coimbatore, Tamil Nadu, India
Rajasekar Nagarajan Department of Cardiology, Sudha Hospitals, Erode, Tamil Nadu, India
Hari Om Tyagi Department of Cardiology, Lokpriya Heart Center, Meerut, Uttar Pradesh, India
Akhil Kumar Sharma Department of Cardiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
Rajeev Garg Department of Cardiology, Gleneagles Aware Hospital, Hyderabad, Telangana, India
Puppanna Mallesh Department of Cardiology, S. S. Narayana Heart Centre, Davangere, Karnataka, India
Hiren Prajapati Department of Medical Affairs, Eris Lifesciences Limited, Ahmedabad, Gujarat, India
Ankita Waghmare Department of Medical Affairs, Eris Lifesciences Limited, Ahmedabad, Gujarat, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20253361

Keywords:

Blood pressure, Diuretics, Hypertension, Indapamide, Thiazides

Abstract

Hypertension is a leading global risk factor for morbidity and mortality, with considerable burden in India, where salt sensitivity and poor blood pressure (BP) control raises the challenges for its management. Diuretics, particularly thiazide agents have key role in hypertension therapy. However, their use is associated with clinically significant metabolic and electrolyte abnormalities. Among the available thiazide diuretics, Indapamide stands out because of to its favourable pharmacological profile, superior efficacy and safety. In contrast to thiazides, Indapamide structures have a lipophilic methylindoline moiety, enhancing vascular penetration. Moreover, its moderate carbonic anhydrase inhibition contributes to potent natriuretic and vasodilatory effects. Its pharmacokinetic properties provide 24-hour control of BP with minimal metabolic and electrolyte imbalance and is effective clinically in moderate renal impairment up to GFR <30-40 ml/min. Clinical evidence and real-world data supports Indapamide’s efficacy as monotherapy and in combinations HTN management, achieving recognition in recent guidelines- ESC 2024, ADA 2025 and Indian guidelines. This review emphasizes Indapamide’s role as an optimal antihypertensive, especially in Indian hypertensive, where BP control is challenge

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