The effect was similar to that obtained when thiazides are used as a single agent .
Thiazides when given as a second-line drug have a dose related effect to lower blood pressure that is similar to when they are added as a first-line drug .
This means that the BP lowering effect of thiazides is additive .
Loop diuretics appear to have a similar blood pressure lowering effect as thiazides at 1 times the recommended starting dose .
Because of the short duration of the trials and lack of reporting of adverse events , this review does not provide a good estimate of the incidence of adverse effects of diuretics given as a second-line drug
BACKGROUND Diuretics are widely prescribed for hypertension not only as a first-line drug but also as a second-line drug .
Therefore , it is essential to determine the effects of diuretics on blood pressure ( BP ) , heart rate and withdrawals due to adverse effects ( WDAEs ) when given as a second-line drug .
Effects of the Combination of Low-Dose Nifedipine GITS 20 mg and Losartan 50 mg in Patients with Mild to Moderate Hypertension
Most hypertensive patients require more than one medication to effectively control elevated blood pressure ( BP ) values . This multicenter , r and omized , double-blind study was aim ed at testing the efficacy and safety of the combination of low-dose nifedipine GITS 20 mg/ losartan 50 mg compared with either monotherapy in patients with grade 1 to 3 hypertension over an eight-week period . Of 352 patients enrolled in the study , 300 were r and omized . All the three treatments lowered elevated BP without clinical ly relevant changes in heart rate . All the three treatments lowered mean 24-hour diastolic BP :  nifedipine GITS/losartan −10.6 mm Hg , losartan −5.4 mm Hg , nifedipine GITS 20 mg −8.0 mm Hg . There was a statistically significant difference of diastolic BP change between patients receiving losartan compared with those receiving combination treatment ( P < 0.05 ) . Diastolic BP trough-to-peak ratio and smoothness index were highest in the patient group receiving combination therapy ( 70 % ) . Nifedipine GITS monotherapy had the highest systolic BP trough-to-peak ratio of all treatment arms ( 78 % ) and higher diastolic BP trough-to-peak ratio and smoothness index than losartan monotherapy . All treatments were safe . These data provide evidence that in hypertensive patients combination of nifedipine GITS 20 mg and losartan 50 mg improves control of systolic and diastolic BP compared with either monotherapy
The effect was similar to that obtained when thiazides are used as a single agent .
Thiazides when given as a second-line drug have a dose related effect to lower blood pressure that is similar to when they are added as a first-line drug .
This means that the BP lowering effect of thiazides is additive .
Loop diuretics appear to have a similar blood pressure lowering effect as thiazides at 1 times the recommended starting dose .
Because of the short duration of the trials and lack of reporting of adverse events , this review does not provide a good estimate of the incidence of adverse effects of diuretics given as a second-line drug
BACKGROUND Diuretics are widely prescribed for hypertension not only as a first-line drug but also as a second-line drug .
Therefore , it is essential to determine the effects of diuretics on blood pressure ( BP ) , heart rate and withdrawals due to adverse effects ( WDAEs ) when given as a second-line drug .