Intraoperative management of potentially fatal arrhythmias after anesthesia induced by severe hypokalemia: A case report / 北京大学学报(医学版)

Severe hypokalemia is defined as the concentration of serum potassium lower than 2.5 mmol/L, which may lead to serious arrhythmias and cause mortality. We report an unusual case of potentially fatal ventricular arrhythmias induced by severe hypokalemia in a patient undergoing laparoscopic partial nephrectomy in Peking University Third Hospital due to irregular use of indapamide before operation. Indapamide is a sulfonamide diuretic with vasodilative and calcium antagonistic effects, which enhances sodium delivery to the renal distal tubules resulting in a dose-related increase in urinary potassium excretion and decreases serum potassium concentrations. The electrolyte disorder caused by the diuretic is more likely to occur in the elderly patients, especially those with malnutrition or long-term fasting. Hence, the serum potassium concentration of the patients under indapamide therapy, especially elderly patients, should be monitored carefully. Meanwhile, the potassium concentration measured by arterial blood gas analysis is different from that measured by venous blood or laboratory test. According to the previous research, the concentration of potassium in venous blood was slightly higher than that in arterial blood, and the difference value was 0.1-0.5 mmol/L. This error should be taken into account when rapid intravenous potassium supplementation or reduction of blood potassium level was carried out clinically. In the correction of severe hypokalemia, the standard approach often did not work well for treating severe hypokalemia. The tailored rapid potassium supplementation strategy shortened the time of hypokalemia and was a safe and better treatment option to remedy life-threatening arrhythmias caused by severe hypokalemia with a high success rate. Through the anesthesia management of this case, we conclude that for the elderly patients who take indapamide or other potassium excretion diuretics, the electrolyte concentration and the general volume state of the patients should be comprehensively measured and fully evaluated before operation. It may be necessary for us to reexamine the serum electrolyte concentration before anesthesia induction on the morning of surgery in patients with the history of hypokalemia. For severe hypokalemia detected after anesthesia, central venous cannulation access for individualized rapid potassium supplementation is an effective approach to reverse the life-threatening arrhythmias caused by severe hypokalemia and ensure the safety of the patients.

Fracturas vertebrales múltiples postsuspensión de denosumab: revisión del tema a partir de dos casos clínicos / Discontinuation of denosumab and multiple vertebral fractures: report of two cases and review of the literature

Los tratamientos para osteoporosis se indican por tiempo variable dependiendo del tipo de droga, anabólica o anticatabólica, y de la gravedad de la enfermedad. Denosumab es un anticuerpo monoclonal totalmente humano que inhibe a RANK-L evitando de esa manera la interacción entre RANKL-RANK, con la consiguiente inhibición de la formación de los osteoclastos, su activación y sobrevida. Disminuye la resorción ósea cortical y trabecular. Su administración subcutánea de 60 mg cada 6 meses al cabo de 3 años ha demostrado reducción de la resorción ósea, incremento de la densidad mineral ósea y disminución de las fracturas vertebrales, no vertebrales y de cadera. Está indicado para el tratamiento de la osteoporosis con alto riesgo de fractura. Su mecanismo de acción es reversible. Se han descripto pérdida de la DMO y elevación de los marcadores de remodelado óseo postsuspensión. Una situación clínica grave son las fracturas vertebrales múltiples postsuspensión. Este evento es infrecuente y se lo atribuye a un rebote del remodelado óseo, postulándose se postula una predisposición especial, probablemente relacionada con microRNA. Se escriben dos mujeres con osteoporosis que presentaron este cuadro. Las fracturas ocurrieron entre 7 y 10 meses posteriores a la última dosis de denosumab. Registraron elevación de C-telopéptidos y disminución de la DMO conjuntamente con las fracturas vertebrales agudas en cascada. (AU)

The duration of osteoporosis treatments depends on the drug type, anabolic or anticatabolic, and the severity of the disease. Denosumab is a fully human monoclonal antibody that inactivates RANK-L, inhibiting the RANKL-RANK interaction . This inhibits osteoclast formation, activation, and survival. It also reduces cortical and trabecular bone resorption. Subcutaneous administration of 60 mg every 6 months for 3 years has reduced bone resorption, increased bone mineral density (BMD) and decreased vertebral, non-vertebral and hip fractures. It is indicated for the treatment of osteoporosis with high risk of fracture. Denosumab mechanism of action is reversible. After discontinuation, loss of BMD and elevation of bone turnover markers have been observed. In addition, multiple vertebral fractures after the suspension of the drug have been reported. These rebound-associated vertebral fractures are rare. A special genetic predisposition related to miRNA has been proposed. Two women with this clinical presentation are described. Fractures occurred between 7 and 10 months respectively after the last dose of denosumab. They presented with an increase in circulating C-telopeptid levels and a decrease inBMD with acute multiple vertebral fractures. (AU)

Reversible Dysphasia and Statins

This paper presents a case of reversible dysphasia occurring in a patient prescribed atorvastatin in combination with indapamide. A milder dysphasia recurred with the prescription of rosuvastatin and was documented on clinical examination. This resolved following cessation of rosuvastatin. The case highlights both a need for a wider understanding of potential drug interactions through the CYP 450 system and for an increased awareness, questioning and reporting of drug side-effects.

A Case of Licorice-Induced Hypokalemic Rhabdomyolysis in a Patient Using a Diuretic Drug / 대한내과학회지

Glycyrrhizic acid is a component of licorice. It can cause hypokalemia through the inhibition of 11beta-hydroxysteroid dehydrogenase. The severity of symptoms depends on the dose and duration of licorice intake, as well as the individual susceptibility. The safe dose of licorice is 10 mg per day. Even a small amount of licorice can cause side effects, including hypokalemia in patients taking diuretics, with diarrhea, or congestive heart failure. We experienced a 59-year-old male with muscle weakness. He had ingested losartan and indapamide due to hypertension. At presentation, he had ingested 8 mg of licorice daily for the previous 17 days. The patient presented with severe hypokalemia (1.8 mEq/L) and rhabdomyolysis. His renin activity was 0.44 ng/mL/h, and his aldosterone level was 6.0 pg/mL. After cessation of licorice and indapamide, his potassium level recovered. In conclusion, even a small amount of licorice can induce hypokalemia in patients who are taking diuretics.

Direct Vascular Actions of Indapamide in Aorta from Renal Hypertensive Rats / 대한신장학회지

PURPOSE: Thiazide diuretics exert their hypotensive efficacy through a combined vasodilator and diuretic effect. The present study was conducted to assess the inhibitory effect of thiazide diuretic, hydrochlorothiazide, and the thiazide-like diuretics, indapamide and chlorthalidone on contractile responses to norepinephrine and arginine vasopressin in aortic rings from 2K1C renal hypertensive and sham-clipped normotensive rats. METHODS: 2K1C hypertension was made by clipping the left renal artery and age-matched control rats received a sham treatment. Changes in the tension of aortic ring preparations were measured isometrically. RESULTS: Indapamide inhibits the contractile responses to norepinephrine and vasopressin in aortic rings from 2K1C rats, while it did not modify in control rats. The inhibitory effect of indapamide was abolished by endothelium removal. Hydrochlorothiazide or chlorthalidone did not affect the vasoconstriction induced by norepinephrine and vasopressin either in sham or in 2K1C hypertensive rats. CONCLUSION: These results suggest that indapamide inhibits the contractile responses to norepinephrine and vasopressin via an endothelium-dependent mechanism in 2K1C renal hypertension.

Regulation of Glucose Control in People with Type 2 Diabetes: A Review and Consensus / 당뇨병

A conference was convened by the Korean Diabetes Association and the Korean Endocrine Society on September 7, 2009 to discuss and organize the results of research on intensive glucose control for the prevention of cardiovascular disease in patients with type 2 diabetes. Professor Kyung Soo Park led the conference, and Professors Kwang Won Kim and Ho Young Son acted as chairmen. Professors Doo Man Kim, Tae Sun Park, and Bong Soo Cha reported on intensive glucose control and diabetic complications, including the UK Prospective Diabetes Study (UKPDS), Diabetes Control and Complication Trial (DCCT) research results, the recently published Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE), and Veterans Affairs Diabetes Trial (VADT) research, as well as meta-analyses. Professor Jeong-Taek Woo reported on the manuscript written by the committee for the Korean Diabetes Association which dealt with the treatment of diabetes mellitus. Professors Kyung Soo Ko, Joong Yeol Park, Hyun Shik Son, Moon-Kyu Lee, Dong-Won Byun, and Yoon-Sok Chung participated in the discussion and collected information for the manuscript from all of the participants. The aim of the debate was to determine how to establish target goals for intensive glucose control and how to individualize those goals. The participants concluded that there was no need to modify the recommendation of maintaining an HbA1c under 6.5%, the current blood glucose treatment goal that is recommended by the Korean Diabetes Association. In addition, individual target goals for glucose control were recommended depending on the situation of each patient. We report on the consensus statement from the meeting.

Regulation of Glucose Control in People with Type 2 Diabetes: A Review and Consensus / 당뇨병

A conference was convened by the Korean Diabetes Association and the Korean Endocrine Society on September 7, 2009 to discuss and organize the results of research on intensive glucose control for the prevention of cardiovascular disease in patients with type 2 diabetes. Professor Kyung Soo Park led the conference, and Professors Kwang Won Kim and Ho Young Son acted as chairmen. Professors Doo Man Kim, Tae Sun Park, and Bong Soo Cha reported on intensive glucose control and diabetic complications, including the UK Prospective Diabetes Study (UKPDS), Diabetes Control and Complication Trial (DCCT) research results, the recently published Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE), and Veterans Affairs Diabetes Trial (VADT) research, as well as meta-analyses. Professor Jeong-Taek Woo reported on the manuscript written by the committee for the Korean Diabetes Association which dealt with the treatment of diabetes mellitus. Professors Kyung Soo Ko, Joong Yeol Park, Hyun Shik Son, Moon-Kyu Lee, Dong-Won Byun, and Yoon-Sok Chung participated in the discussion and collected information for the manuscript from all of the participants. The aim of the debate was to determine how to establish target goals for intensive glucose control and how to individualize those goals. The participants concluded that there was no need to modify the recommendation of maintaining an HbA1c under 6.5%, the current blood glucose treatment goal that is recommended by the Korean Diabetes Association. In addition, individual target goals for glucose control were recommended depending on the situation of each patient. We report on the consensus statement from the meeting.

Effects of valsartan and indapamide on plasma cytokines in essential hypertension / 中南大学学报(医学版)

OBJECTIVE@#investigate and compare the effect of valsartan and indapamide on inflammatory cytokines in hypertension.@*METHODS@#Forty-one untreated patients with mild to moderate hypertension and 20 age and sex-matched normotensives were enrolled in this study. Hypertensives were treated with indapamide 1.5 mg/d (n=20) or valsartan 80 mg/d (n=21) for 4 weeks, and blood samples for determining monocyte chemotactic protein-1 (MCP-1), macrophage inflammatory protein-1 (MIP-1alpha), sP-selectin, asymmetric dimethylarginin (ADMA), angiotensin II (Ang II), and 6-keto-PGF1alpha were collected before the treatment and 4 weeks after the treatment.@*RESULTS@#Hypertensives exhibited significantly higher blood pressure, as well as elevated plasma levels of MCP-1, MIP-1alpha, sP-selectin and serum level of ADMA compared with the normotensives. Nevertheless, there was no significant difference in serum 6-keto-PGF1alpha and Ang II between the hypertensives and the normotensives. After the treatment with indapamide or valsartan for 4 weeks, both the systolic and diastolic blood pressures, though still higher than those of the normotensives, decreased markedly. After the treatment with indapamide for 4 weeks, MCP-1, MIP-1alpha and sP-selectin slightly decreased, but not statistically significant (P>0.05). Those cytokines decreased significantly after being treated with valsartan for 4 weeks [(19.16+/-3.11) pg/mL vs (16.08+/-2.67) pg/mL, P0.05).@*CONCLUSION@#The levels of MCP-1, MIP-1alpha, sP-selectin and ADMA were elevated in mild to moderate hypertensives. Valsartan and indapamide have similar blood pressure lowering effect. Valasartan exerts more significant effect on cytokines than indapamide does.

The comparison of the effect of enalapril and indapamide on the peripheral blood pressure and central blood pressure through pulse wave analysis / 中华心血管病杂志

<p><b>OBJECTIVES</b>The purpose of this study was to evaluate the effects of the angiotensin-converting enzyme (ACE) inhibitor enalapril and diuretic indapamide on the peripheral blood pressure and the central blood pressure in Chinese patients with essential hypertension.</p><p><b>METHODS</b>This study was a double blind, randomized study. Informed consent were given by all patients. After 2 weeks of placebo run-in period, 105 patients with mild or moderate essential hypertension were randomized to receive either enalapril (10 mg per day) or indapamide (2.5 mg per day) for 8 weeks. Radial pulse wave recordings were performed in all the patients before the active treatments were given and at the end of the study. Only those patients who have finished 8 weeks of active treatment in both groups were included into the final analysis.</p><p><b>RESULTS</b>One hundred one patients (51 in enalapril group and 50 in indapamide group) completed the study. No significant difference (all P values > 0.05) was found in baseline data between the two groups. After 8 weeks of treatment, all the parameters of pulse wave (except heart rates in both groups and augmentation index in indapamide group) decreased significantly. Comparison of the 2 groups showed that there were no significant differences (all P values > 0.05) in all the parameters of pulse wave except that the central systolic blood pressure, augmentation and augmentation index were significantly lower in enalapril group than in indapamide group. In enalapril group, the reduced values of systolic blood pressure and pulse pressure in central aorta were significantly larger than those in brachial artery. However, the difference was not observed in indapamide group.</p><p><b>CONCLUSIONS</b>Enalapril and indapamide are both similarly effective in reducing peripheral arterial blood pressure. Moreover, enalapril is more effective in reducing central systolic pressure and augmentation index than indapamide. The difference is probably due to the reduction of wave reflection caused by enalapril.</p>

A Randomized Crossover Study of the Additive Effect of Lercanidipine and Indapamide in Patients with the Mild to Moderate Hypertension

BACKGROUND AND OBJECTIVES: There is evidence available from randomized control trials about the additive effects of combination regimens that are mainly based on diuretics and beta-blockers or ACE inhibitors. Yet there are some arguments about the effect of the combination of calcium channel blockers (CCBs) and diuretics. We aimed to study the blood pressure-lowering effects of lercanidipine, indapamide or a combination therapy on the home blood pressure (HBP) and the 24-hour ambulatory blood pressure (ABP), and we wanted to examine the agreement with using these two methods. SUBJECTS AND METHODS: 70 patients participated in this randomized open crossover design study. The treatments in each phase were 10 mg lercanidipine (L) and 1 mg indapamide (I), separately and also in combination (L+I). Each patient had their HBP checked twice during each phase and the 24h ABP was checked in two of the 3 phases. We also measured the agreement between the HBP and ABP by using a Bland-Altman plot. RESULTS: 58 patients (mean age: 49+/-9 (31-71) years; 37 males and 21 females) completed the study. The blood pressure was significantly reduced during all the active treatments compared with the baseline (L: 160.2+/-12/100.3+/-9 mmHg, I; 130.5+/-9.3/86.0+/-8.1 mmHg, 129.2+/-12.9/83.9+/-11.1 mmHg, L+I:124.9+/-10.9/81.3+/-8.5 mmHg, p<.000) and the BP for the combination therapy was also significantly less than those BPs for both the other monotherapies (L+I vs. L: p<.002, L+I vs. I: p<.01) by measuring the 24h ABP. The Bland-Altman plot showed+/-25 mmHg for the limit of agreement between both measurement methods. CONCLUSION: CCB and diuretics were effective agents for treating hypertensive patients. As a combination therapy, the effects on blood pressure are additive. Poor agreement of the blood pressures with using the two measurement methods was observed.

New drugs for treatment of hypertension / 대한내과학회지

Recently several kinds of new antihypertensive agents were introduced. Diuretics such as indapamide, metyrazone and eprelerone have less side effects compared to thiazide, and have an effect in renal insufficiency. Carvedilol, combined alpha- and beta- adrenergic blocker, has a vasodilating property and an effect on heart failure. The lipid soluble third generation calcium antagonists such as amlodipine, lacidipine and lercardipine are slow onset and long acting and have less side effects, which provide continued effect even if daily doses are missed. Multiple angiotensin converting inhibitors and angiotensin receptor blockers, and the specific aldosterone antagonist eprenolone to block renin-angiotensin-aldosterone system are now available. Additionally new class antihypertensive drugs such as the vasopeptidase inhibitor, the endothelin receptor blocker and the renin inhibitor have been under investigation and shown favorable clinical results, and will be available for clinical use soon.

Evaluación de la eficacia y tolerancia del cambio inmediato de indapamida 2.5 mg a indapamida 1.5 mg Lp (en monoterapia o en asociación con otras drogas antihipertensivas) en hipertensos leves y moderados / Effectiveness and tolerance evaluation of the inmediate change of idapamide 2.5 mg to indapamide 1.5 mg Lp (inmonotherapy or association with other antihypertensive drugs) in ligth or moderate hipertensive

La terapia antihipertensiva con 2.5 mg de indapamida, sola o asociada con otra droga hipotensiva, puede ser sustituida , en pacientes hipertensos, por indapamida de 1.5 mgLp, sin que se altere la efectividad de los resultados. En un estudio de diseño abierto, se estudiaron pacientes hipertensos (HP)-leves y moderador-(OMS) de los dos sexos, con edades comprendidas entre los 20 y los 70 años. Un total de 43 participantes se distribuyeron en tres grupos: a) Los nuevos participantes hipertensos incorporados al estudio (14) recibieron placebo durante 15 días. Luego se les administró 2.5 mg de idapamida QD durante tres meses. Para entonces si la presión arterial (PA) estaba bajo control (Presión Arterial Sistólica-PAS-<140mmHg y la Presión Arterial Diastólica -PAD-<90 mmHg, en las posiciones sentada y de pie), se sustituía el tratamiento por 1.5mg de indapamina LP durante tres meses más. b) Los pacientes hipertensos (17) que estaban ya bajo el tratamiento y control de 2.5 mg de indapamina en por lo menos los tres mese previos, fueron observados por 15 días y luego tratados con 1.5 mg de indapamida LP por tres mese más. c) Los pacientes hipertensos (12) que estaban bajo control y tratamiento de 2.5 mg de indapamina en asociación con otra droga hipotensiva, también por lo menos los tres meses previos, fueron seguidos por 15 días y luego tratados durante tres meses con 1.5 mg de indapamina LP, sin abandonar la otra droga antihipertensiva. Todos los pacientes fueron sometidos periódicamente a evaluaciones de laboratorio y electriocardiogramas. En los grupos: a) La PAS y la PAD disminuyeron significativamente después de los tres meses de tratamiento: 140.6-118.1 (p= 0.0020)/93.8-83.6 (p= 0.0061) y se mantuvieron controladas por tres meses más. b) La PAS y la PAD se mantuvieron estables (121.4-127.5/78.4-78.4). c) La PAS y la PAD se mantuvieron estables y más aún los valores disminuyeron después de los 3 meses. (131.2-121.0/81.6-78.1). Los registros de PA que se muestran fueron tomados en posición sentada. Los valores en posición de pie fueron similares. Los ECGs no mostraron cambios significativos ni importantes en ninguno de los grupos. Los exámenes de laboratorio mostraron cambios significativos en la creatinina en los grupos A y B pero no anormales y un aumento significativo de la HDL en el grupo A. La dosis de 1.5 mg de indapamina LP fue bien tolerada por todos los participantes

Indapamida en hipertensión arterial geriátrica: experiencia ecuatoriana / Indapamide in geriatric arterial hypertension: ecuadorian experience

Se estudiaron 37 pacientes con edades comprendidas entre los 60 y 95 años con un predominio de HA sistólica después de un período de lavado de 15 días, los pacientes comenzaron a recibir 2,5 mg de Indapamida diariamente por 120 días. Se hizo una evaluación a los 60 y 120 días. Se determinaron además diversas variables bioquímicas, incluyendo lípidos. el análisis de los resultados evidenció que la Indapamida hizo descender tanto las cifras de la TA sistólica, como de la TA diastólica, pero básicamente la primera, aunque ambas descendieron en forma significativa. Esto aunado a los pocos efectos secundarios y a su nula acción sobre la bioquímica sanguínea, la hacen una droga de primera elección para el tratamiento de ese tipo de HA

Modification of the antihypertensive effect of indapamide by indomethacin.

Oral treatment with indapamide was found to reduce blood pressure of hypertensive rats but not of normotensive rats. Chronic indomethacin treatment had no effect on blood pressure of untreated normotensive and hypertensive rats. Also indomethacin did not modify the antihypertensive effect of indapamide excluding the direct involvement of PGs in the antihypertensive effect of indapamide. Vascular reactivity to pressor agents NA, ADR and ANG was significantly increased after indomethacin treatment. This may be due to the blockade of the actions of PG in modifying vascular reactivity to vasoconstrictor agents or may be a direct effect of indomethacin on calcium fluxes. Indapamide reduced the reactivity to NA and ANG in the presence of indomethacin suggesting that the antihypertensive effect of indapamide may be through a decrease in reactivity to pressor agents which is independent of increase in the synthesis of vasodilator PGs.

Efecto hemodinámico arterial periférico de indapamida en la hipertensión arterial / Peripheral arterial hemodynamic effect of indapamide in hipertension

Indapamida, fármaco hipotensor con propiedades diuréticas, fue probado en su posible efecto vasodilatador directo arterial en un grupo de 20 hipertensos esenciales moderados, 12 hombres y 8 mujeres, con edad promedio de 58 +- 9,2 años (rango 47 - 71 años) mediante estudio hemodinámico no invasivo de la arteria braquial, usando un sistema Duplex Eco-doppler que permite determinar el diámetro y la velocidad media de flujo arterial; mediante la determinación simultánea de la P.A. en la misma arteria con el método del manguito, se puede calcular resistencia y compliance arterial. Indapamida se usó en dosis crecientes de 2,5 y 5 mg durante 12 semanas. La dosis de 2,5 mg. produjo un descenso significativo de la P.A., acompañado de aumento del diámetro de la arteria braquial y aumento de la velocidad de flujo arterial. Concomitantemente, se observó una reducción de la resistencia periférica y aumento de la compliance arterial. Con la dosis de 5 mg. no hubo mayor reducción de la P.A. ni mayor aumento de la velocidad de flujo, pero sí un aumento mayor de diámetro arterial y del volumen circulante con reducción mayor de la R. periférica. La distensibilidad aumentó en forma no proporcional a la reducción de la P.A. Se concluye que indapamida vasodilata simultáneamente arteriolas y grandes arterias, lo que sugiere fuertemente un efecto directo de la droga sobre el tono arterial y/o las propiedades viscoelásticas de la pared de grandes arterias

Efectos hemodinámicos y bioquímicos de la indapamida en pacientes hipertensos estudio multicentrico ecuatoriano / Hemodinamic and biochemical effects of the indapamide in hypertensive patients: multicentry ecuatorial study

Se estudiaron 85 pacientes con hipertensión arterial leve y moderada en dos poblaciones de Ecuador. Los pacientes fueron distribuidos en dos grupos: a) indapamina y b) placebo. Todos los pacientes fueron evaluados desde el punto de vista cardiovascular, haciéndosele también determinaciones de variables bioquímicas, incluyendo el perfil lipídico. También se practicaron electrocardiogramas de reposo y de esfuerzo. Los pacientes fueron seguidos por un lapso de 120 días. El análisis de los resultados finales evidencian que la indapamida, a una dosis de 2,5 mgs, ejerció una buena acción hipotensora sostenida, tanto en la tensión arterial diastólica como en la sistólica y en las tres posiciones. Los efectos secundarios fueron mínimos, mostrando una buena tolerancia. El grupo bajo indapamida mostró alza significativa en la HDL-C al igual que un descenso en el colesterol total y en la LDL, lo cual se tradujo en un descenso en las razones de riesgo aterosclerótico. En conclusión, la indapamida es un buen hipotensor, eficaz y bien tolerado

Clinical Observation on Antihypertensive Effect of Indapamide(Fludex(R))

The antihypertensive effect of Indapamide(Fludex(R)) was studied in 31 patients of essential hypertension and following results were obtained. 1) Daily dosage was 1mg b.i.d. and total duration of medication was weeks. 2) Mean systolic and diastolic blood pressure declined by 23mmHg(14%) and 18mmHg(17%) respectively. 3) Good or fair controls were achieved in 78% of patients. 4) There was no significant change in heart rate during and after treatment. 5) There were no significant changes in fasting blood sugar, serum creatinine, K+, uric acid, ca++, transaminase and cholesterol levels before and after treatment. 6) In 5 patients transient side effects were observed which resolved spontaneously. In view of these results Indapamide appears to be effective agent for the treatment of mild to moderate hypertension and dose not cause significant change in blood chemistry.