Guidelines recommend diuretics and calcium channel blockers (CCBs) to treat systolic hypertension in the older patient. This NESTOR substudy examines the antihypertensive effect of this combination in hypertensive diabetic patients aged≥65 years.

To evaluate the long-term antihypertensive efficacy and safety of indapamide SR/amlodipine in≥65 year olds, in the randomized, double-blind, 1-year NESTOR study.

The NESTOR study included 570 hypertensive (aged 35-80 years, systolic blood pressure [SBP] 140-180 and diastolic blood pressure [DBP]<110mmHg), diabetic patients with microalbuminuria, 187 of whom were aged≥65 years. Antihypertensive therapy was stopped before inclusion and indapamide SR 1.5mg or enalapril 10mg administered. If target BP (<140/90mmHg) was not achieved at 6 weeks, amlodipine 5mg was added with uptitration to 10mg if needed. Follow-up period was 52 weeks.

At 52 weeks in 107 patients aged≥65 years receiving bitherapy, SBP/DBP decreased significantly (P<0.001) from baseline by 30±12/ 14±9mmHg with indapamide SR/amlodipine (n=53) vs 22±16/11±9mmHg with enalapril/amlodipine (n=54). There was a significantly greater SBP reduction of 6.2±2.7mmHg (P=0.02, adjusted on baseline) with indapamide SR/amlodipine vs enalapril/amlodipine, a larger difference than that seen in all ages on bitherapy (4.1±1.5mmHg; P=0.006). Moreover, BP response rate (<140/90mmHg or decrease of 20mmHg in SBP or 10mmHg in DBP) in≥65 year olds was greater with indapamide SR/ amlodipine (88%) than with enalapril/amlodipine (75%). Indapamide SR and amlodipine were associated with a good safety profile. Three patients in each group discontinued treatment.

This analysis confirms that a thiazide-like diuretic/CCB combination (indapamide SR/amlodipine) more effectively lowers SBP than an angiotensin-converting enzyme inhibitor/CCB combination in these hypertensive patients aged≥65 years, whilst maintaining a good safety profile.