Low-dose diuretic and/or dietary sodium restriction when blood pressure is resistant to ACE inhibitor.

Aim: To compare the efficacy of indapamide (1.25 mg daily) and low-salt diet (< 100 mmol/day) separately and in combination in essential hypertensive patients with inadequate BP response to perindopril. Design and Methods: Randomized double-blind, double-dummy, crossover design. The randomized treatments were indapamide 1.25 mg daily, sodium chloride 80 mmol daily, the combination of indapamide and sodium chloride and placebo. All patients received perindopril 4 mg daily and maintained a low-sodium diet. Results: 19 patients entered and 17 completed the study. Prior to randomization, average clinic sitting blood pressure was 162/101 mmHg and average 24-h urine sodium excretion was 157 mmol/day. Compared to the phase in which patients received perindopril with sodium repletion, clinic and ambulatory BPs were significantly reduced (p < 0.01) in all the other phases. Indapamide had a greater effect on BP than dietary sodium restriction, and in combination their effects were additive. The effect of inda...