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 .
Amlodipine and lisinopril in combination for the treatment of essential hypertension: efficacy and predictors of response
Objective : We have shown previously that the combination of captopril and nifedipine was effective at peak response but was very short acting . We therefore decided to study the longer-acting angiotensin converting enzyme inhibitor lisinopril and the long-acting calcium antagonist amlodipine , each alone and in combination , in a double-blind , r and omized crossover study in which blood pressures were measured at peak and trough . This study provided the opportunity to investigate what parameters in these patients might possibly predict the fall in blood pressure with the individual drugs and with the combination Methods : Fifteen patients with essential hypertension ( eight male , 10 Caucasian ; mean age 53 years ) were studied . After 1 month observation on no treatment they were entered into a single-blind run-in of placebo given once a day for 1 month . Patients were then allocated r and omly to amlodipine ( 5 mg once a day ) , lisinopril ( 10 mg once a day ) or their combination ( once a day ) for 1 month in a double-blind crossover study . All patients were studied on their usual diet and no dietary advice was given . Blood pressure was measured by semi-automatic ultrasound sphygmomanometer both 24 h and 6 h ( trough and peak ) after the last dose Results : During the crossover part of the study there was a significant additional blood pressure-lowering effect ( at trough ) of the combination compared with either amlodipine or lisinopril alone . Similar results were observed for the blood pressures at peak . The fall in blood pressure with lisinopril was related to baseline plasma renin activity , whereas when amlodipine was given , either alone or in combination , the fall in blood pressure was independent of baseline renin activity . The Blacks ( n=5 ) appeared not to respond as well to lisinopril as the Caucasians ( n=10 ) . Finally , the blood pressure response to amlodipine tended to be associated with the severity of hypertension Conclusions : The results of the present study indicate that : amlodipine and lisinopril in combination have a marked additional effect on blood pressure compared with either given as a monotherapy ; their potentiation of action is long-acting ; Black patients tend not to respond to the monotherapy with lisinopril as well as Caucasian patients , although they respond similarly to the combination ; the response to amlodipine tends to be greater the higher the initial blood pressure ; and , finally , the response to lisinopril is greater the higher the plasma renin
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 .