From the Guidelines
No, indapamide is not an ACE inhibitor. Indapamide is a thiazide-like diuretic medication used to treat high blood pressure and fluid retention, as stated in the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1. It works by increasing the amount of salt and water that the kidneys remove from the blood, which reduces blood volume and lowers blood pressure. ACE inhibitors, on the other hand, work through a completely different mechanism by blocking the angiotensin-converting enzyme, which prevents the formation of angiotensin II, a powerful vasoconstrictor. Common ACE inhibitors include medications like lisinopril, enalapril, and ramipril.
The 2024 ESC guidelines recommend ACE inhibitors, ARBs, dihydropyridine CCBs, and diuretics (including thiazides and thiazide-like drugs such as indapamide) as first-line treatments for hypertension 1. Indapamide is often prescribed at doses of 1.25 to 2.5 mg once daily for hypertension. It's essential to distinguish between these medication classes because they have different side effect profiles, contraindications, and may be used in different clinical scenarios or in combination for blood pressure management. The guidelines also discuss the importance of combining medications, such as a RAS blocker with a dihydropyridine CCB or diuretic, for more effective blood pressure control 1.
Key points to consider when prescribing indapamide or ACE inhibitors include:
- The mechanism of action: indapamide increases urine production, while ACE inhibitors block the angiotensin-converting enzyme
- The recommended dosage: indapamide is typically prescribed at 1.25 to 2.5 mg once daily
- The potential side effects: indapamide and ACE inhibitors have different side effect profiles
- The clinical scenarios: indapamide and ACE inhibitors may be used in different scenarios or in combination for blood pressure management, as recommended by the 2024 ESC guidelines 1 and further discussed in the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1.
From the FDA Drug Label
Indapamide is the first of a new class of antihypertensive/diuretics, the indolines. It differs chemically from the thiazides in that it does not possess the thiazide ring system and contains only one sulfonamide group The answer is: No, indapamide is not an ACE inhibitor. It is an antihypertensive/diuretic that belongs to a different class of drugs, the indolines 2, 2.
From the Research
Indapamide Classification
- Indapamide is not an ACE inhibitor, but rather a thiazide-related diuretic with antihypertensive properties 3, 4.
- It has a dual mechanism of action, including a diuretic effect and a direct vascular effect, which contributes to its antihypertensive efficacy 3, 5.
Comparison with ACE Inhibitors
- Indapamide can be used in combination with ACE inhibitors, and this combination has been shown to be effective in lowering blood pressure and protecting against target organ damage 4, 6, 7.
- The combination of indapamide and an ACE inhibitor has been found to have a favorable safety profile, with a lower rate of hypokalemia and metabolic abnormalities compared to other diuretics 6.
Mechanism of Action
- Indapamide's antihypertensive effect is thought to be due to its diuretic action, as well as its direct vascular action, which may be related to its calcium channel blocking properties 3, 4.
- Indapamide has also been shown to have other effects, including limiting the production of free radicals and endothelium-dependent vasoconstrictor substances, which may contribute to its beneficial properties 4.