Antihypertensive efficacy and side effects of three beta‐blockers and a diuretic in elderly hypertensives: a report from the STOP‐Hypertension study The stroke preventive effect in elderly hypertensives cannot fully be explained by the reduction in office blood pressure--insights from the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). Effectiveness of Add-On Low-Dose Diuretics in Combination Therapy for Hypertension: Losartan/Hydrochlorothiazide vs. Candesartan/Amlodipine Dual blockade of the renin-angiotensin system in type 1 patients with diabetic nephropathy. Potassium supplementation in the treatment of idiopathic postural hypotension. Potassium chloride lowers blood pressure and causes natriuresis in older patients with hypertension. Telmisartan plus hydrochlorothiazide versus telmisartan or hydrochlorothiazide monotherapy in patients with mild to moderate hypertension: a multicenter, randomized, double-blind, placebo-controlled, parallel-group trial. Effect of allopurinol on blood pressure and aortic compliance in hypertensive patients Predictors of Hyperkalemia Risk following Hypertension Control with Aldosterone Blockade Use of diuretics is associated with reduced risk of Alzheimer's disease: the Cache County Study Impact of Empagliflozin on Blood Pressure in Patients With Type 2 Diabetes Mellitus and Hypertension by Background Antihypertensive Medication The influence of oral potassium chloride on blood pressure in hypertensive men on a low-sodium diet. The effect of vitamin D supplementation on blood pressure in patients with elevated blood pressure and vitamin D deficiency: a randomized, double-blind, placebo-controlled trial Decreasing dietary sodium while following a self-selected potassium-rich diet reduces blood pressure. Mechanism(s) of selective systolic blood pressure reduction after a low-dose combination of perindopril/indapamide in hypertensive subjects: comparison with atenolol. Relation between low dose of hydrochlorothiazide, antihypertensive effect and adverse effects. Efficacy of potassium and magnesium in essential hypertension: a double-blind, placebo controlled, crossover study. Correlates of blood pressure in an urban Zimbabwean population and comparison to other populations of African origin Effect of indapamide on serum and red cell cations, with and without magnesium supplementation, in subjects with mild hypertension. Use of 24-Hour Ambulatory Blood Pressure Monitoring to Assess Antihypertensive Efficacy ACE inhibitors, beta-blockers, calcium blockers, and diuretics for the control of systolic hypertension. Physician-pharmacist co-management and 24-hour blood pressure control. Low-dose antihypertensive treatment with a thiazide diuretic is not diabetogenic. A 10-year controlled trial with bendroflumethiazide.
Objective : To compare the blood pressure‐lowering efficacy , the frequency of side effects and changes in laboratory values of three & bgr;‐blockers and a potassium‐sparing diuretic combination in elderly hypertensive patients . Design : The Swedish Trial in Old Patients with Hypertension ( STOP‐Hypertension ) was a prospect i ve , r and omized , double‐blind , multicentre trial comparing active antihypertensive treatment with placebo in patients aged 70‐84 years . Methods : The study group consisted of 1627 elderly hypertensive patients ( mean ± SD age 75.7 ± 3.7 years ; 37 % males , 63 % females ) . Supine and st and ing blood pressure , heart rate and side effects were recorded at each visit . Blood was drawn for routine analysis . The mean length of follow‐up was 25 months ( range 6‐65 ) . No patient was lost to follow‐up . Results : After 2‐months ' single‐drug therapy , all four active drugs were found to be equally effective in reducing diastolic blood pressure ( DBP ) . However , there were differences in their efficacy in reducing systolic blood pressure ( SBP ) ; the diuretic was significantly more effective than the & bgr;‐receptor blockers . The results of a series of multiple linear regression analyses showed that the observed differences in effect on SBP could not be explained by the different effects of the drugs on heart rate . More than two‐thirds of the patients were given supplementary treatment , most of them already by the 2‐month visit , after which there was no significant difference in blood pressure among the treatment regimens . The changes in laboratory values and in the prevalence of symptoms were minor for all four regimens . Conclusion : Metoprolol ( controlled release ) , atenolol , pindolol and the combination hydrochlorothiazide + amiloride were equally effective as single drugs in reducing DBP . There were differences in their efficacy in reducing SBP , the diuretic being more effective than the & bgr;‐blockers . After addition of supplementary treatment ( & bgr;‐blocker to diuretic , or vice versa ) there were no significant differences in blood pressure reduction among the groups . The changes in laboratory values and in the prevalence of symptoms were minor for all active treatment regimens . Thus , the satisfactory effect on cardiovascular morbidity and mortality was not impaired by low tolerability of the drugs OBJECTIVE To study whether the cardiovascular preventive effect of antihypertensive therapy can be explained solely by the reduction in office blood pressure , and to what extent the risk of stroke and cardiac events is associated with in- study diastolic blood pressure ( DBP ) and systolic blood pressure ( SBP ) . DESIGN The Swedish Trial in Old Patients with Hypertension ( STOP-Hypertension ) was a prospect i ve , r and omized , double-blind , multicentre trial comparing active antihypertensive treatment with placebo in patients aged 70 - 84 years . The study group comprised 1,627 elderly patients ( mean blood pressure 195/102 mm Hg ; mean age 75.7 , SD 3.7 ; 63 % females ) . The average follow-up was 25 months ( range 6 - 65 months ) . No patient was lost to follow-up . METHOD We applied a Poisson model taking current age , sex , treatment , DBP and SBP into account for all patients in the study . The constants of the model were estimated by the maximum likelihood method . RESULTS The risk of stroke was significantly lower ( 42 % , p = 0.0402 ) for a patient on active therapy than for a patient on placebo having the same blood pressure level , age , and sex . There was a corresponding , non-significant , reduction in cardiac events of 21 % . In the whole study group the risk of stroke increased by 3 % per mmHg ( p = 0.0247 ) with increasing diastolic blood pressure for a given systolic pressure . The corresponding value for cardiac events was 2 % per mmHg ( p = 0.0376 ) . CONCLUSION In STOP-Hypertension we found a substantial risk reduction in stroke in actively treated patients , which was not solely explained by the blood pressure reduction obtained by treatment with beta-blockers and a potassium-sparing diuretic combination In guidelines , a combination therapy of two or more antihypertensives is recommended for treatment of hypertension where monotherapy is ineffective . Although diuretics or calcium channel blockers are commonly used as add-ons to angiotensin receptor blocker ( ARB ) , the most effective and safe combination has not been established . In this r and omized 4-month study , the efficacy and safety were compared between an ARB/diuretics ( losartan/hydrochlorothiazide [ HCTZ ] ) combination and the most prescribed combination , ARB/calcium channel blocker ( c and esartan/amlodipine ) in hypertensive patients for whom 8 mg/day of c and esartan proved ineffective . After 36 patients were recruited and allocated into two groups , changes in blood pressure ( BP ) and laboratory values were analyzed in 31 patients : 16 patients received losartan ( 50 mg/day)/HCTZ ( 12.5 mg/day ) ( L/H group ) , and 15 patients received c and esartan ( 8 mg/day)/amlodipine ( 5 mg/day ) ( C/A group ) after 5 patients were withdrawn . After 4 months , L/H significantly ( p<0.001 ) reduced mean systolic BP (SBP)/diastolic BP ( DBP ) from baseline 160/89±13/11 mmHg to 140/80±9/8 mmHg , and C/A reduced BP from 161/90±10/11 mmHg to 141/79±10/7 mmHg . The efficacy in reducing BP was similar between the two combination therapies . L/H significantly reduced serum potassium , but within the normal range , and did not increase serum uric acid or serum triglyceride . With L/H , the percentage of patients who attained the BP goal in SBP was higher in elderly patients than in younger patients . As L/H is more cost-effective than c and esartan/amlodipine and has fewer adverse effects on uric acid and other metabolic parameters than diuretic monotherapy , it is concluded to be useful for the management of hypertension BACKGROUND Albuminuria and hypertension are predictors of poor renal and cardiovascular outcome in patients with diabetes . Approximately 30 % of type 1 patients with diabetic nephropathy ( DN ) have albuminuria > 1 g/day , and blood pressure > 135 and /or > 85 mmHg despite antihypertensive therapy with recommended doses of ACE inhibitor ( ACEI ) and diuretics . We tested the effect of dual blockade of the renin-angiotensin system ( RAS ) in these patients . METHODS We performed a r and omised double blind crossover trial with 2 months treatment with Irbesartan 300 mg o.d . and placebo added on top of previous antihypertensive treatment . We included 21 type 1 patients with DN responding insufficiently to ACEI and diuretics , as defined above . At the end of each treatment period , albuminuria , 24-h blood pressure and glomerular filtration rate ( GFR ) were measured . RESULTS Addition of 300 mg Irbesartan to the patients ' usual antihypertensive therapy induced a mean reduction in albuminuria of 37 % ( 95 % CI 20 - 49 , P<0.001 ) ; from 1574 mg/24 h ( 95 % CI 1162 - 2132 ) to 996 mg/24 h ( 95 % CI 699 - 1419 ) , a reduction in 24-h blood pressure of 8 mmHg systolic ( 95 % CI -2 to 18 ) and 5 mmHg diastolic ( 95 % CI 1 - 9 ) ( P=0.11 and 0.01 , respectively ) ( from placebo , mean ( SE ) 146 (4)/80 ( 2 ) mmHg ) . GFR remained unchanged . Serum potassium increased ( mean 4.3 to 4.6 mmol/l , P=0.02 ) . Intervention to reduce serum potassium was needed in two patients with GFR < 35 ml/min/1.73 m(2 ) . Otherwise the dual blockade with Irbesartan was safe and well tolerated . CONCLUSIONS Dual blockade of the RAS may offer additional renal and cardiovascular protection in type 1 patients with DN responding insufficiently to conventional antihypertensive therapy , including recommended doses of ACEI and diuretics We studied the effects of potassium supplementation ( 60 mmol/day ) and matching placebo on the postural blood-pressure fall in ten elderly patients with symptomatic idiopathic postural hypotension in a double-blind , r and omized cross-over trial . There was a significant decrease in the orthostatic fall in systolic blood pressure ( SBP 33 + /- 5 mmHg to 16 + /- 9 mmHg , p less than 0.01 ) and in supine SBP ( 162 + /- 7 to 150 + /- 7 mmHg , p less than 0.01 ) between placebo and potassium phases . Supine diastolic and erect blood pressures were unchanged , though pulse rate showed a greater orthostatic increase ( 7 + /- 3 beats/min to 14 + /- 2 beats/min , p less than 0.05 ) following potassium therapy . No significant changes were seen in intracellular electrolytes , plasma renin activity , aldosterone levels or body weight . Seven patients reported symptomatic improvement with potassium , but none during the placebo phase . Potassium therapy was well tolerated and may be a successful and safe method of treating idiopathic postural hypotension Epidemiologic surveys , experimental studies in animals , and clinical trials in young and middle-aged patients with hypertension indicate that dietary potassium lowers blood pressure . The mechanism of the antihypertensive effect is not well defined . Variations in serum potassium within the physiologic range may directly affect vascular smooth muscle tone . Potassium may also influence the regulation of blood pressure through effects on sodium h and ling , aldosterone secretion , the renin/angiotensin system , renal kallikrein , eicosanoids , and atrial natriuretic peptide . This study was undertaken to confirm the blood pressure-lowering effect of potassium in older patients and to determine the mechanism of the antihypertensive effect . Twenty-two patients greater than or equal to 60 yr of age were admitted to a Clinical Research Unit for 8 days after a 2-wk period free of antihypertensive medication . Patients were placed on an isocaloric diet containing 200 mmol/day of Na+ , 70 mmol/day of K+ , and 500 mg/day of Ca2 + and were treated in a r and omized , double-blinded manner with either potassium chloride ( 120 mmol/day ) or placebo . After 4 days , patients were crossed over to the alternate treatment . Systolic blood pressure decreased 8.6 mm Hg ( 95 % confidence interval -14.6 , -2.6 ) , and diastolic blood pressure decreased 4.0 mm Hg ( -6.9 , -1.0 ) during potassium chloride supplementation . There was no significant change in blood pressure during treatment with placebo . Serum K+ was 3.9 + /- 0.1 mmol/L after 3 days of placebo and 4.3 + /- 0.1 after 4 days of potassium chloride ( P less than 0.002 ) . Urinary sodium excretion averaged 192 + /- 11 mmol/day after placebo and 221 + /- 8 after potassium treatment ( P less than 0.02 ) . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND Recent surveys reveal continuing deficiencies in the awareness , treatment , and control of hypertension . In many cases , failure to achieve blood pressure targets may be attributable to the use of antihypertensive monotherapy . OBJECTIVES This study was undertaken to identify combinations of telmisartan , a new oral angiotensin II type 1-receptor antagonist , and hydrochlorothiazide ( HCTZ ) that might provide greater antihypertensive efficacy than monotherapy with either agent in the treatment of mild to moderate hypertension . It also examined the dose-response surface for the 2 drugs alone and in combination . METHODS This was a multicenter , r and omized , double-blind , placebo-controlled , parallel-group study that employed all cells of a 4 x 5 factorial design . After a 4-week , single-blind , placebo run-in period , men and women between 18 and 80 years of age with mild to moderate hypertension ( defined as mean supine diastolic blood pressure [ DBP ] between 95 and 114 mm Hg during the last 2 weeks of the placebo run-in period and systolic blood pressure [ SBP ] between 114 and 200 mm Hg immediately before r and omization ) were eligible to enter the 8-week , double-blind , double-dummy treatment period . Study comparisons were between once-daily telmisartan monotherapy ( 20 , 40 , 80 , or 160 mg ) , HCTZ monotherapy ( 6.25 , 12.5 , or 25 mg ) , 12 combinations of these telmisartan/HCTZ doses , and placebo . The focus was on 2 combinations : telmisartan 40 mg/HCTZ 12.5 mg and telmisartan 80 mg/HCTZ 12.5 mg . The primary efficacy variable was change in supine trough DBP from baseline to the last evaluable measurement during double-blind treatment . Plasma renin activity and safety parameters , including treatment-emergent adverse events , physical findings , electrocardiograms , and serum electrolyte levels ( which are known to increase with HCTZ treatment ) , were also assessed . RESULTS Of 1293 patients screened , 818 ( 63.3 % ) were enrolled at 47 centers . Of these 818 , 749 ( 91.6 % ) completed the study . The intent-to-treat population ( r and omized with > or = 1 postr and omization blood pressure measurement ) consisted of 807 patients ( 98.7 % ) . Telmisartan 80 mg/HCTZ 12.5 mg significantly decreased mean supine trough SBP/DBP by 23.9/14.9 mm Hg , a benefit of 8.5/3.4 mm Hg compared with telmisartan 80 mg and of 17.0/7.6 mm Hg compared with HCTZ 12.5 mg ( both comparisons , P < 0.01 ) . Telmisartan 40 mg/HCTZ 12.5 mg significantly reduced mean supine SBP by 18.8 mm Hg , a benefit of 6.6 mm Hg compared with telmisartan 40 mg and 11.9 mm Hg compared with HCTZ 12.5 mg ( both , P < 0.01 ) . This same combination significantly reduced mean supine DBP by 12.6 mm Hg , a benefit of 5.3 mm Hg compared with HCTZ 12.5 mg ( P < 0.01 ) , but was not significantly different from telmisartan 40 mg . Telmisartan 80 mg/HCTZ 12.5 mg was significantly more effective than telmisartan 40 mg/HCTZ 12.5 mg in reducing mean supine DBP and SBP ( both , P < 0.05 ) . The response surface and responder analyses confirmed the additive antihypertensive efficacy of the combination of telmisartan and HCTZ . All regimens were well tolerated . CONCLUSIONS Once-daily telmisartan 80 mg/HCTZ 12.5 mg was effective and well tolerated when used to reduce SBP and DBP in patients with mild to moderate hypertension . In addition to enhancing efficacy , this combination protected against potassium depletion , a common side effect of thiazide monotherapy Abstract Background . Arterial hypertension is commonly associated with hyperuricemia . Several studies have shown that allopurinol reduces arterial blood pressure in animal models and in adolescent patients with newly diagnosed hypertension . Moreover , allopurinol has shown beneficial effects on endothelial function and arterial wave reflection in contrast to uricosuric agents . Antihypertensive drugs produce different effects on serum uric acid levels . Objective . The aim of the study was to evaluate the influence of allopurinol on blood pressure and aortic compliance in patients with arterial hypertension depending on hypotensive therapy with angiotensin-converting enzyme inhibitor ( ACE-I ) or thiazide diuretic , hypotensive drugs with distinct effects on serum uric acid levels and conversely , a positive influence on pulse wave velocity ( PWV ) in the aorta . Material and Methods . Sixty-six patients aged 25–70 ( mean age 46.17 ± 10.89 ) with mild and moderate arterial hypertension diagnosed on the basis of office blood pressure , were studied . They were r and omized to antihypertensive therapy on either perindopril ( n = 35 ) or hydrochlorothiazide ( n = 31 ) . After 8 weeks of antihypertensive therapy , 150 mg of allopurinol daily was added for the next 8 weeks . Measurement of the serum uric acid level , PWV and 24-h ambulatory blood pressure monitoring ( ABPM ) were performed at baseline , after 8 weeks antihypertensive therapy and again after the final 8 weeks with the additional allopurinol . Results . No significant changes in systolic ( SBP ) and diastolic blood pressure ( DBP ) or ABPM were observed after allopurinol treatment in either of the subgroups receiving ACE-I or thiazide-based antihypertensive therapy . The mean PWV decreased from 10.7 ± 1.4 m/s to 10.0 ± 1.2 m/s ( p = 0.00008 ) in the ACE-I-based therapy subgroup and from 11.5 ±1.7 m/s to 10.4 ± 1.5 m/s ( p = 0.00002 ) in the thiazide-based therapy subgroup after treatment with allopurinol . However , significant correlations were found between PWV changes and the basic PWV ( r = −0.52 ; p < 0.001 ) or SBP changes ( r = 0.29 ; p < 0.019 ) after allopurinol treatment . Conclusions . Allopurinol does not produce additional antihypertensive effects in patients with treated arterial hypertension . Allopurinol increases aortic compliance independently of ACE-I or thiazide-based , antihypertensive therapy . However , this effect is significantly dependent on the initial PWV in the aorta and on SBP changes during allopurinol therapy Background : Aldosterone antagonists have proven efficacy for management of resistant hypertension and proteinuria reduction ; however , they are not widely used due to risk of hyperkalemia . This study assesses the risk factors for hyperkalemia in patients with chronic kidney disease ( CKD ) and resistant hypertension whose blood pressure ( BP ) is reduced to a guideline goal . Methods : This is a two-center study conducted in university-based hypertension clinics directed by clinical hypertension specialists . Forty-six patients with resistant hypertension and stages 2 or 3 CKD ( mean estimated glomerular filtration rate ( eGFR ) 56.5 ± 16.2 ml/min/1.73 m2 ) were evaluated for safety and efficacy of aldosterone blockade added to preexisting BP-lowering regimens . All patients were on three mechanistically complementary antihypertensive agents including a diuretic and a renin-angiotensin system blocker . Patients were evaluated after a median of 45 treatment days . The primary endpoint was change in systolic BP . Secondary endpoints included change in serum potassium , creatinine , eGFR , diastolic BP and tolerability . Results : The mean age of the patients studied was 64.9 ± 10.7 years , all were obese and 86 % had type 2 diabetes , with 82 % being African-American . Addition of aldosterone antagonism yielded a further mean reduction in systolic BP of 14.7 ± 5.1 mm Hg ( p = 0.001 ) . Females with BMI > 30 and those with a baseline systolic BP > 160 mm Hg were more likely to have a greater BP reduction to aldosterone antagonism . In total , 39 % of the patients had a > 30 % decrease in eGFR when the BP goal was achieved . The mean increase in serum potassium was 0.4 mEq/l above baseline ( p = 0.001 ) , with 17.3 % manifesting hyperkalemia , i.e. serum potassium > 5.5 mEq/l . Predictors of hyperkalemia included a baseline eGFR of ≤45 ml/min/1.73 m2 in whom serum potassium was > 4.5 mEq/l on appropriately dosed diuretics . Contributing risks in this subgroup included a systolic BP reduction of > 15 mm Hg associated with an eGFR fall of > 30 % . Conclusion : Aldosterone antagonism is effective and safe for achieving a BP goal among people with diabetic nephropathy when added to a triple antihypertensive regimen that includes a blocker of the renin-angiotensin system and an appropriately selected and dosed diuretic . Caution is advised when using aldosterone blockade for BP control in people with advanced stage 3 nephropathy with a serum potassium of > 4.5 mEq/l for safety reasons Although the use of antihypertensive medications has been associated with reduced risk of Alzheimer 's disease ( AD ) , it remains unclear which class provides the most benefit . The Cache County Study of Memory Health and Aging is a prospect i ve longitudinal cohort study of dementing illnesses among the elderly population of Cache County , Utah . Using waves I to IV data of the Cache County Study , 3417 participants had a mean of 7.1 years of follow-up . Time-varying use of antihypertensive medications including different class of diuretics , angiotensin converting enzyme inhibitors , β-blockers , and calcium channel blockers was used to predict the incidence of AD using Cox proportional hazards analyses . During follow-up , 325 AD cases were ascertained with a total of 23,590 person-years . Use of any antihypertensive medication was associated with lower incidence of AD ( adjusted hazard ratio [ aHR ] , 0.77 ; 95 % confidence interval [ CI ] , 0.61 - 0.97 ) . Among different classes of antihypertensive medications , thiazide ( aHR , 0.7 ; 95 % CI , 0.53 - 0.93 ) , and potassium-sparing diuretics ( aHR , 0.69 ; 95 % CI , 0.48 - 0.99 ) were associated with the greatest reduction of AD risk . Thiazide and potassium-sparing diuretics were associated with decreased risk of AD . The inverse association of potassium-sparing diuretics confirms an earlier finding in this cohort , now with longer follow-up , and merits further investigation In the EMPA-REG BP trial , empagliflozin 10 mg and 25 mg once daily reduced glycohemoglobin , blood pressure ( BP ) , and weight versus placebo in patients with type 2 diabetes mellitus and hypertension . Patients  received placebo ( n=271 ) , empagliflozin  10 mg ( n=276 ) , or empagliflozin 25 mg ( n=276 ) for 12 weeks ( n = full analysis set ) . This present analysis investigated changes from baseline to week 12 in mean 24-hour systolic BP ( SBP ) and diastolic BP ( DBP ) in patients receiving 0 , 1 , or ≥2 antihypertensive medications and patients receiving/not receiving diuretics or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers . Compared with placebo , empagliflozin 10 mg and 25 mg reduced mean 24-hour SBP/DBP in patients receiving 0 ( 10 mg : −3.89/−2.58 mm Hg ; 25 mg : −3.77/−2.45 mm Hg ) , 1 ( 10 mg : −4.74/−1.97 mm Hg ; 25 mg : −4.27/−1.81 mm Hg ) , or ≥2 ( 10 mg : −2.36/−0.68 mm Hg ; 25 mg : −4.17/−1.54 mm Hg ) antihypertensives . The effect of empagliflozin was not significantly different between subgroups by number of antihypertensives for changes in SBP ( interaction P value 0.448 ) or DBP ( interaction P value 0.498 ) . Empagliflozin  reduced 24-hour mean SBP/DBP irrespective of diuretic or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use , with no significant difference between subgroups by use/no use of diuretics ( interaction P values 0.380 [ systolic ] ; 0.240 [ diastolic ] ) or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers ( interaction P values 0.900 [ systolic ] ; 0.359 [ diastolic ] ) . In conclusion , in patients with type 2 diabetes mellitus and hypertension  , empagliflozin for 12 weeks reduced SBP and DBP  versus placebo , irrespective of the number of antihypertensives and use of diuretics or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers . Clinical Trial Registration —URL : https:// clinical trials.gov . Unique identifier : NCT01370005 Clinical and epidemiologic studies suggest that the intake of potassium chloride lowers blood pressure . To investigate whether supplemental potassium chloride ( 96 mmol of microcrystalline potassium chloride a day ) reduced the need for antihypertensive medication in hypertensive men on a restricted-sodium diet , we conducted a r and omized , placebo-controlled , double-blind clinical trial . A total of 287 men 45 to 68 years of age , 142 given potassium chloride and 145 given placebo  , were followed for an average of 2.2 years after the withdrawal of their antihypertensive medication . Men in both groups received instructions on following a low-sodium diet .  Overnight urinary sodium excretion fell from 63 mmol per eight hours at base line to an average of 45 mmol per eight hours during follow-up . Participants given supplemental potassium chloride had significantly higher ( P less than 0.001 ) serum potassium levels and urinary potassium excretion ( averaging 4.5 mmol per liter and 42.5 mmol per eight hours , respectively ) during follow-up than participants given placebo ( 4.2 mmol per liter and 20.0 mmol per eight hours ) . Seventy-nine participants in each group required reinstitution of antihypertensive medication according to strict indications defined by the protocol . No significant differences in systolic or diastolic blood pressure were observed between the two groups . During follow-up , systolic and diastolic blood pressure averaged 130.6 and 82.5 mm Hg , respectively , for participants given supplemental potassium , and 132.5 and 83.1 mm Hg for participants given placebo . We conclude that supplemental potassium chloride does not reduce the need for antihypertensive medication in hypertensive men on a restricted-sodium diet Objectives The present evidence indicates a reverse correlation between vitamin D status and blood pressure ( BP ) . The present study determined the effect of oral vitamin D supplementation on BP in patients with elevated BP and vitamin D deficiency . Material s and methods In this r and omized , double-blind , placebo-controlled trial , 42 out patients with elevated BP and vitamin D deficiency were assigned r and omly to two groups : the vitamin D-supplemented group ( VDG ) , who received one capsule containing 50 000 IU of cholecalciferol weekly , and the placebo group ( PG ) , who received one similar capsule containing oral liquid paraffin as placebo for 8 weeks . The systolic ( SBP ) and diastolic ( DBP ) blood pressures , mean arterial blood pressure ( MAP ) , pulse pressure , serum 25-hydroxyvitamin D , parathormone , calcium , phosphorus , magnesium , sodium , and potassium were measured before and after the intervention . Results In all , 92.7 % of the VDG recovered from vitamin D deficiency . At the end of the intervention , the mean SBP and DBP , and the MAP decreased significantly in VDG compared with the PG , whereas at the beginning of the intervention , there was no significant difference between the two groups . The mean changes in SBP ( −6.4±5.3 vs. 0.9±3.7 mmHg , PV<0.001 ) , DBP ( −2.4±3.7 vs. 1.0±2.7 mmHg , PV=0.003 ) , and MAP ( −3.7±3.6 vs. 0.9±2.5 mmHg , PV<0.001 ) were lower in the VDG than PG . Conclusion The findings of the study showed that the weekly administration of 50 000 IU of oral vitamin D for 8 weeks as an adjunct supplement of antihypertensive drugs in patients with vitamin D deficiency could help prevent vitamin D deficiency and aid control of SBP , DBP , and MAP Reducing dietary sodium reduces blood pressure ( BP ) , a major risk factor for cardiovascular disease , but few studies have specifically examined the effect on BP of altering dietary sodium in the context of a high potassium diet . This r and omized , crossover study compared BP values in volunteer subjects self- selecting food intake and consuming low levels of sodium ( Na+ ; 50 mmol/d ) with those consuming high levels of sodium ( > or = 120 mmol/d ) , in the context of a diet rich in potassium ( K+ ) . Sodium supplementation ( NaSp ) produced the difference in Na+ intake . Subjects ( n = 108 ; 64 women , 44 men ; 16 on antihypertensive therapy ) had a mean age of 47.0 + /- 10.1 y. Subjects were given dietary advice to achieve a low sodium ( LS ) diet with high potassium intake ( 50 mmol Na+/d , > 80 mmol K+/d ) and were allocated to NaSp ( 120 mmol Na+/d ) or placebo treatment for 4 wk before crossover . The LS diet decreased urinary Na+ from baseline , 138.7 + /- 5.3 mmol/d to 57.8 + /- 3.8 mmol/d ( P < 0.001 ) . The NaSp treatment returned urinary Na+ to baseline levels 142.4 + /- 3.7 mmol/d . Urinary K+ increased from baseline , 78.6 + /- 2.3 to 86.6 + /- 2.1 mmol/d with the LS diet and to 87.1 + /- 2.1 mmol/d with NaSp treatment ( P < 0.001 ) . The LS diet reduced home systolic blood pressure ( SBP ) by 2.5 + /- 0.8 mm Hg ( P = 0.004 ) , compared with the NaSp treatment . Hence , reducing Na+ intake from 140 to 60 mmol/d significantly decreased home SBP in subjects dwelling in a community setting who consumed a self-selected K+-rich diet , and this dietary modification could assist in lowering blood pressure in the general population OBJECTIVES The goal of this study was to determine if a low-dose combination of the angiotensin-converting enzyme inhibitor perindopril ( Per ) and the diuretic indapamide ( Ind ) reduces central ( thoracic aorta , carotid artery ) as well as brachial systolic blood pressure ( SBP ) more than the beta-blocker atenolol and to determine the hemodynamic factors influencing independently brachial and central SBP : pulse wave velocity ( PWV ) and pattern of wave reflections . BACKGROUND In high cardiovascular risk population s , angiotensin blockade improves survival without affecting brachial SBP and diastolic blood pressure ( DBP ) . Whether central SBP , which is physiologically lower than brachial SBP , is significantly reduced has never been investigated . METHODS This study was a double-blind r and omized trial for one year in patients with essential hypertension . RESULTS For a similar DBP reduction , Per/Ind decreased SBP significantly more than atenolol , with a more pronounced reduction for central than for brachial SBP . After one year , the difference between brachial and central SBP was maintained by Per/Ind ( 8.28 + /- 1.53 mm Hg ) and significantly attenuated by atenolol ( 0.29 + /- 1.61 mm Hg ) . Under atenolol , the principal factor modulating SBP reduction was mean blood pressure . Under Per/Ind , this parameter played a minor role , and the central SBP reduction implied a major role for disturbed PWV and wave reflections . CONCLUSIONS Under Per/Ind , but not atenolol , normalization of brachial SBP is achieved with a significantly greater reduction of central SBP . This hemodynamic profile reflects changes of wave reflections issued from distal arterial and arteriolar territory , where Per/Ind , but not atenolol , is known to improve vessel wall structure Thiazide diuretics are widely used in the drug treatment of hypertension but their dose-response curves for the antihypertensive and adverse metabolic effects differ . To characterize the lower end of the dose-response curve a double-blind , parallel group trial was performed as multicentre study in Sc and inavia . One hundred and eleven patients with newly diagnosed or previously treated mild to moderate hypertension ( untreated diastolic blood pressure of 95 - 115 mmHg after 4 weeks placebo ) were r and omly allocated to various doses of hydrochlorothiazide ( 3 , 6 , 12.5 or 25 mg ) or placebo for 6 weeks . Blood pressure and biochemical variables ( plasma renin activity , serum potassium , magnesium , urate , fasting glucose , total cholesterol , HDL-cholesterol , triglycerides and apolipoproteins A1 and B were measured . 12.5 mg hydrochlorothiazide had a borderline effect on blood pressure whilst 25 mg had a definite antihypertensive effect . Biochemical changes were seen in plasma renin activity , serum potassium and urate after the 12.5 and 25 mg dose . Three and 6 mg had no effect on blood pressure or metabolic parameters OBJECTIVE --To evaluate the antihypertensive activity of potassium given alone or in combination with magnesium in patients with mild hypertension . DESIGN --A double blind , r and omised , placebo controlled , crossover trial of 32 weeks ' duration . SETTING S -- Cardiology outpatient department , Sassoon General Hospitals , Pune , India . PATIENTS --37 Adults with mild hypertension ( diastolic blood pressure less than 110 mm Hg ) . INTERVENTION-- Patients received either placebo or potassium 60 mmol/day alone or in combination with magnesium 20 mmol/day in a crossover design . No other drug treatment was allowed . MEASUREMENTS --Blood pressure and heart rate assessed at weekly intervals and biochemical parameters at monthly intervals . RESULTS --Potassium alone or in combination with magnesium produced a significant reduction in systolic and diastolic blood pressures ( p less than 0.001 ) and a significant reduction in serum cholesterol concentration ( p less than 0.05 ) ; other biochemical variables did not change . Magnesium did not have an additional effect . Urinary potassium excretion increased significantly in the groups who received potassium alone or in combination with magnesium . The drug was well tolerated and compliance was satisfactory . CONCLUSION --Potassium 60 mmol/day lowers arterial blood pressure in patients with mild hypertension . Giving magnesium as well has no added advantage We have evaluated the relationship between systolic blood pressure ( SBP ) and age , body mass index ( BMI ) , waist circumference , sodium to potassium ratio ( Na/K ) , and tobacco use in an urban African population . We conducted a r and om , population -based , cross-sectional survey of people 25 years and older in Marondera , Zimbabwe , with over-sampling in older age groups ( n = 775 ) , using a method comparable to that used in International Collaborative Study on Hypertension in Blacks ( ICSHIB ) . The age-adjusted prevalences of hypertension in Marondera ( SBP ⩾140/DBP ⩾90/antihypertensive medication ) were 30 % for women and 21 % for men . The average BMI was 26.3 kg/m2 for women and 21.4 kg/m2 for men . The prevalence of hypertension had a steep association with age and in women ranged from 15 % ( 25–34 years ) to 63 % ( 55 years and over ) and in men from 9 % to 47 % . No tobacco use in women and greater Na/K ratio in spot urines in men were significantly associated with an increased SBP . In both men and women the levels of hypertension and SBP were strongly positively associated with BMI , although the relationship appeared to plateau in women with a BMI greater than ⩾25 kg/m2 . At a given BMI , men and women had similar SBPs and prevalences of hypertension . There is a very high prevalence of hypertension among urban Zimbabweans , particularly among women . Under the assumption the studies are comparable , the prevalence of hypertension in Zimbabwean women ( 41 % ) and men ( 26 % ) after age adjustment to the ICSHIB population s , appeared higher than almost all of the ICSHIB population s , including those with higher average body mass indexes Unlike some thiazide diuretics , indapamide -- a non-thiazide chlorosulphonamide derivative -- has been shown to have a magnesium-sparing effect in normotensive subjects . This effect has not been studied in hypertensive subjects . In a r and omised double-blind trial indapamide 2,5 mg and placebo were given daily to a group of elderly patients with mild hypertension , with and without supplemental magnesium chloride .  Blood pressure and serum and red blood cell cations were measured . The significant antihypertensive effect of indapamide was confirmed . There was no effect of indapamide on serum and red cell magnesium concentrations compared with placebo , both with and without magnesium supplementation . Indapamide induced hypokalaemia with a shift of sodium into the red cells . In this group of elderly hypertensive subjects  indapamide induced potassium but not magnesium loss Abstract Introduction : Goal rates , the percentage of patients with hypertension achieving recommended SBP/DBP , are a clinical ly important assessment of an antihypertensive agent ’ efficacy . Twenty-four-hour ambulatory blood pressure monitoring ( ABPM ) allows accurate assessment of a patient ’s hypertension and risk for cardiovascular events , and provides the most accurate measure of an antihypertensive agent ’s efficacy throughout a 24-hour dosing interval . Methods : A 12-week ( 4-week single-blind placebo run-in phase followed by an 8-week double-blind active treatment phase ) r and omized , parallel-group study reported that the recommended starting dose of the angiotensin II receptor antagonist ( angiotensin receptor blocker ; ARB ) olmesartan medoxomil ( Benicar ™ ) 20 mg/day was more effective than starting doses of losartan potassium ( Cozaar ® ) 50 mg/day , valsartan ( Diovan ® ) 80 mg/day , or irbesartan ( Avapro ® ) 150 mg/day in reducing cuff DBP in patients with essential hypertension . The present report includes analyses of secondary efficacy variables from this 12-week trial . Results : The mean reduction in blood pressure from baseline to week 8 ( end of treatment ) was significantly greater with olmesartan medoxomil than with valsartan for all ABPM times analyzed ( 24 hours , daytime , night-time , and last 2 and 4 hours of monitoring ) . Statistical significance was reached for comparisons of oimesartan medoxomil with losartan potassium for a majority of times analyzed and with irbesartan for SBP in the last 4 hours of monitoring . Goal rates for accepted critical ambulatory blood pressure ( ABP ) values of < 130/80 mm Hg for mean 24-hour ABP , < 135/85 mm Hg for mean daytime ABP , and < 120/75 mm Hg for mean night-time ABP were significantly greater for patients receiving olmesartan medoxomil than for those receiving losartan potassium or valsartan . Goal rates were numerically superior , but not statistically significant , to those achieved with irbesartan . Compared with losartan potassium or valsartan recipients , a significantly higher percentage of patients treated with olmesartan medoxomil achieved the 24-hour ABP goal of < 130/85 mm Hg . The last 2 and 4 hours of ABPM indicated that olmesartan medoxomil maintained larger mean decreases in blood pressure through the morning surge . Discussion / Conclusion : ABP goal rates are a meaningful measure of antihypertensive efficacy . The effects on mean change from baseline in ABP and ABP goal rates after 8 weeks of treatment were numerically better , but not statistically significant , for olmesartan medoxomil than for irbesartan . However , olmesartan medoxomil was significantly more effective than losartan potassium or valsartan The objective of this study was to determine which of the common groups of antihypertensive drugs is most effective at lowering systolic blood pressure ( SBP ) in elderly patients with previously untreated hypertension and the percentage of patients controlled with single or sequential monotherapy . Subjects were recruited from patients attending other outpatient clinics and entered into the study if their SBP was more than 150 mm Hg after three visits . Patients were given a low and high dose of each of the main classes of drugs or placebo for 1 month each . The study was a balanced , r and omized crossover design with five periods : placebo ; angiotensin converting enzyme inhibitors ; beta-blocking drugs ; calcium-blocking drugs ; and thiazide diuretics .  Blood pressure ( BP ) was measured 24 to 26 h after the previous dose . A question naire for side effects was administered at each visit . Seventy-four patients entered the study . beta-Blockers could not be used in 15 patients because of asthma or bronchospasm and these had two placebo periods . There were 9 of 66 patients on P , 9 of 46 on beta-blockers , 4 of 65 on calcium-blocking drugs , 4 of 65 on diuretic , and 1 of 62 patients on ACE inhibitors who did not progress to the higher dose because of side effects . Decreases in SBP compared to r and omized placebo were calcium-blocking drugs 15 mm Hg = diuretic 13 mm Hg > ACE inhibitors 8 mm Hg = beta-blockers 5 mm Hg . Blood pressure decrease correlated with placebo BP ( P < .0005 , r = 0.53 to 0.70 ) . When corrected for placebo , target SBP ( < 140 mm Hg ) was reached in between 6 % to 15 % of patients on monotherapy . Sequential monotherapy achieved target in 29 % . Angiotensin converting enzyme inhibitors , calcium-blocking drugs , and diuretics had no more side effects than placebo . Patients on beta-blockers had more side effects and the well-being score was reduced . Diuretics and calcium-blocking drugs are more effective in elderly patients at lowering SBP pressure . beta-Blockers were relatively ineffective , were frequently contraindicated , and had more side effects . Monotherapy achieved control in only a small number of patients . In elderly people with essential hypertension , therapy should be instituted with diuretics or calcium-blocking drugs , but combination therapy will usually be required to achieve goal The objectives of this study were to compare indices of 24-hour blood pressure ( BP ) following a physician-pharmacist collaborative intervention and to describe the associated changes in antihypertensive medications . This was a secondary analysis of a prospect i ve , cluster-r and omized clinical trial conducted in 6 family medicine clinics r and omized to co-managed ( n=3 clinics , 176 patients ) or control ( n=3 clinics , 198 patients ) groups .  Mean ambulatory systolic BP ( SBP ) was significantly lower in the co-managed vs the control group : daytime BP 122.8 mm Hg vs 134.4 mm Hg ( P<.001 ) ; nighttime SBP 114.8 mm Hg vs 123.7 mm Hg ( P<.001 ) ; and 24-hour SBP 120.4 mm Hg vs 131.8 mm Hg ( P<.001 ) , respectively . Significantly more drug changes were made in the co-managed than in the control group ( 2.7 vs 1.1 changes per patient , P<.001 ) , and there was greater diuretic use in co-managed patients ( 79.6 % vs 62.6 % , P<.001 ) . Ambulatory BPs were significantly lower for the patients who had a diuretic added during the first month compared with those who never had a diuretic added ( P<.01 ) . Physician-pharmacist co-management significantly improved ambulatory BP compared with the control group . Antihypertensive drug therapy was intensified much more for patients in the co-managed group Blood pressure ( BP ) and metabolic variables were determined initially and after 1 , 2 , 4 , 6 and 10 years ' treatment in two groups of hypertensive men ( n = 53 each ) r and omized to bendroflumethiazide 2.5 - 5 mg/day or propranolol 160 - 320 mg daily . There was no significant differences in BP or metabolic variables between the two groups at entry . BP was reduced to the same degree by both treatments . Five men in the propranolol group and one man in the thiazide group developed clinical ly overt diabetes during follow-up . Fasting blood sugar increased slightly but significantly though equally in both groups . Oral glucose tolerance was initially impaired to the same degree in both groups but improved significantly during treatment with both drugs . Fasting insulin increased slightly but to the same degree . While serum potassium decreased significantly in the thiazide group , the total body potassium was unchanged in this group . In the propranolol group , serum potassium rose , while total body potassium decreased significantly . Serum urate increased in both groups , though slightly more during thiazide treatment . One case of gout was found in each group . There was no difference in serum lipids between the two groups . The finding in this long-term trial indicate that in middle-aged men with mild to moderate hypertension a low-dose thiazide diuretic like bendroflumethiazide is as effective and safe an antihypertensive agent as the beta-blocker propranolol is and that it does not induce diabetes . The total clinical picture favors the retention of thiazide diuretics as a first choice drug in hypertension
Differences in antihypertensive effect were due to potency rather than efficacy .
This synthesis accomplishes for PSDs what has already been achieved for thiazide-type diuretics and other antihypertensives and can guide the application of these underutilized medicines
BACKGROUND Potassium-sparing diuretics ( PSDs ) are valuable antihypertensives with additional benefits unrelated to control of systolic blood pressure ( SBP ) .
However , their key parameters affecting SBP and serum potassium are poorly defined , fostering underutilization .