Diuretics have side effects like hyponatrimia, hypokalemia, dyslipedemia.. Among Chlorthalidone and indepamide which one is best in terms of side effects and efficacy according to available data?
Chlorthalodone was tested in the ALLHAT study and indapamide in the EUROPA and other studies in association with perindopril. Both are reference diuretics for the treatment of hypertension.
Metabolic side effects are less pronounced with indapamide. This means effects on insulin resistance and on potassium.
The main message however is that HCT is inferior to the abovementioned drugs. See excellent work of Franz Messerli and Bangalore, S.
Indepamide is better antihypertensive drug. It is very less likely to cause dyslipedemia, hyperuricemia and hypokalemia. It has got unique renoprotective effect. In 1991Gambardella first published an article about renoprotective effect of long term indepamide use..
Another interesting aspect of indepamide in treating isolated systolic hypertension is that it reduces the systolic pressure without much reduction of diastolic pressure. It reduces the pulse pressure. So it could be a very useful in treating isolated systolic hypertension in elderly. All these observations were seen in X-CELLENT study. In this study amlodepine, candesartan and indepamide sustained release preparation were compared in treating isolated systolic hypertension and indepamide was very effective in reducing systolic pressure without much reduction of diastolic pressure..