Although many data indicate that the management of
hypertension has improved over the last two decades, there is still a large proportion of hypertensive individuals who do not receive adequate management of their blood pressure (BP). Combination
therapy with two or more
antihypertensive agents from different
drug classes is increasingly being recognised as the most effective means of achieving target BP values by pharmacological means, particularly in the large number of patients in whom monotherapy proves to be ineffective. Use of an
angiotensin-converting enzyme (
ACE) inhibitor combined with a
diuretic is a well established
antihypertensive combination that is very effective because of the different, yet synergistic, mechanisms of actions of agents from these two
drug classes.
Delapril is a potent
antihypertensive ACE inhibitor, and
indapamide is a
thiazide-like
diuretic with additional
antihypertensive properties. The combination of
delapril and
indapamide provides renoprotective effects, and
indapamide is also cardioprotective. Use of these two drugs together is therefore a rational selection for combination
therapy, and one that has consistently demonstrated lowering of BP to target values with a level of efficacy that is at least as good as other combinations of
ACE inhibitors and
diuretics. This combination has also been found to provide favourable effects on haemodynamic parameters, including left ventricular mass index and ejection fraction. Furthermore, combining an
ACE inhibitor and a
thiazide-type
diuretic has been associated with a decreased risk of
stroke and is recommended for patients with
cerebrovascular disease, a setting in which the combination of
delapril and
indapamide has therapeutic potential. Because of the additive mechanisms of
delapril and
indapamide, the dose required for an effective
antihypertensive effect is relatively low, and the combination is well tolerated at such doses. In particular, metabolic effects normally associated with
diuretics are rare at the therapeutic dose of
indapamide used in combination with
delapril, making the combination suitable for patients with metabolic disorders in whom
diuretic therapy would otherwise not be recommended.
Delapril 30 mg and
indapamide 2.5mg have been combined in a fixed combination, offering the convenience of a one-
tablet-per-day
antihypertensive drug regimen for most patients, which, along with good tolerability, helps to address the issue of noncompliance.