• In this study, Natrilix SR is proven to reduce microalbuminuria significantly by 46%.
• Treatment with Natrilix SR resulted in target BP achievement in 87% patient population.
• Besides efficacy, Natrilix SR was very well tolerable during the entire study period of 1 year.
• As proven in this study, Natrilix SR was not less effective than Enalapril in reducing Microalbuminuria and BP in elderly hypertensive patients with type 2 diabetes, consistent with the use of Natrilix SR as first line antihypertensive treatment in this patient population.

(Gosse P, Sheridan DJ, Zannad F, et al. Regression of Left ventricular hypertrophy   in   hypertensive   patients   treated   with   Indapamide  SR  1.5  mg  Versus  Enalapril  20  mg :  the  LIVE  study. J Hypertens. 2000;18:1465-1475.)

A new study has challenged traditional thinking by showing that a diuretic antihypertensive, Natrilix SR (indapamide SR 1.5 mg), significantly outperforms the ACE inhibitor enalapril in reversing left ventricular hypertrophy (LVH) in hypertensive patients.

It is well established that LVH, a common condition in patients with high blood pressure, is a key cardiovascular risk factor, and that achieving regression of LVH results in significantly improved patient outcomes. Previous research has suggested that ACE inhibitors may be more effective than diuretics in reversing LVH. But, to date, the scant evidence in this area has been based mainly on meta-analyses that often lack the power to compare the treatments properly: they often include small, uncontrolled studies, with short periods of treatment and different methodologies in LVH assessment. Therefore, there has been a pressing need for well-designed studies of LVH regression.
The LIVE study is an attempt to solve the problem: the trial is the first in LVH regression to fulfil the criteria for optimal trial design. LIVE is a randomized, double-blind, parallel-group study, with adequate size and gender mix, and 1-year duration. In addition, in designing the trial, the researchers focused on improving the quality of the echocardiography: in order to minimize investigator bias, an independent committee performed a continuous quality control of all echocardiograms during the study and a final assessment of all the recordings blinded for center, patient identification, treatment, and visit date (sequence of recording). This last point, not fulfilled in other studies, is a major strength of LIVE, since even a blind reader might be psychologically conditioned by the sequence of the echocardiograms.

In the international LIVE study, 411 patients were given either Natrilix SR, one tablet daily, or enalapril 20 mg/day. The two drugs achieved similar blood pressure reductions, but Natrilix SR has been shown to be superior to enalapril 20 mg in reversing LVMI (-5.8% versus -1.4% p=0.013) by acting directly at the cardiac wall level, and through a progressive action over 1 year.

There is not enough evidence to extrapolate Natrilix SR's performance to the diuretic class as a whole. The researchers attribute Natrilix SR's effectiveness to its direct influence on the cardiac wall, reducing both the posterior wall and septum thickness. Other diuretics have only shown reductions in the internal diameter of the ventricle.

It seems reasonable to conclude that LVH regression is an important target of antihypertensive therapy. The LIVE study, a good example of the kind of studies needed to assess the effect of antihypertensive treatment to reverse LVH, demonstrates that Natrilix SR, one tablet daily, can be proposed as an effective treatment in hypertensive patients with LVH.