CARDIOVASCULAR JOURNAL OF AFRICA • SAHS Biennial Congress 16-18 September 2022 27 AFRICA Submission ID: 1365 Introduction Although renal mechanisms are well-recognised determinants of primary hypertension, this has only recently been demonstrated to translate into persistent volume-dependent primary hypertension in some populations (African ancestry). Diuretic agents have never been demonstrated to produce persistent reductions in systemic flow, but the effect of these agents in volume-dependent primary hypertension has never been assessed. We aimed to determine the effect of the thiazide-like diuretic, indapamide on systemic flow in a population with persistent volume-dependent hypertension. Methods After a 2-week washout period in those receiving therapy, mild hypertensives of African ancestry were randomized to receive either indapamide (2.5 mg)(n=28) or amlodipine (10 mg) (n=24) daily for one month and then to receive the angiotensin-converting enzyme inhibitor, perindopril (8 mg) as add-on therapy if target office pressures had not been achieved, for a further 5 months. We assessed arterial hemodynamics from non-invasive central arterial pressure, aortic velocity and diameter measurements (outflow tract)(echocardiography) at baseline, 1 month and 6 months. Results Both groups showed decreases in systemic vascular resistance (SVR)(p<0.05) and characteristic impedance (Zc)(p<0.05), and increases in total arterial compliance (TAC)(p<0.05) However, amlodipine-based therapy produced increases in stroke volume (SV)(p<0.05), cardiac output (CO)(p<0.005), and peak aortic flow (Q)(p<0.05), effects which were not noted in the group receiving indapamide therapy. However, indapamide failed to reduce SV, CO or Q. Conclusion In volume-dependent mild hypertension, the thiazide-like diuretic, although preventing vasodilator-associated increases in systemic flow, is unable to reduce BP through reductions in systemic flow. These data suggest that presently available diuretic agents are unable to adequately manage the volume-dependent hemodynamic component of primary hypertension in Africa. Name: Presenting Author Information Article Category Abstract Title Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. vernice.peterson@wits.ac.za English Abstract Population Sciences Impact of Thiazide-Like Diuretic Based Therapy on Increases in Systemic Blood Flow in Volume-Dependent Hypertension in Africa. Author Affiliation: Email: Vernice R Peterson Authors Name & Surname Title Expertise Affiliation Email Country Elena Libhaber Prof Cardiovascular Physiology Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg South Africa Suraj M Yusuf Mr Cardiovascular Physiology Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg yusufmsuraj@kasu.edu.ng South Africa Nonhlanhla Mthembu Miss Cardiovascular Physiology Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg nonhlanhla.mthembu@wits.ac.za South Africa ORAL PRESENTATION
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