Direct comparison of doses did not show evidence of dose dependence for blood pressure-lowering for any of the other thiazides for which RCT data were available : bendrofluazide , chlorthalidone , cyclopenthiazide , metolazone or indapamide .
This is based on an informal indirect comparison of results observed in other Cochrane review s on ACE inhibitors , ARBs and renin inhibitors compared with placebo , which used similar inclusion /exclusion criteria to the present review .Thiazides reduced potassium , increased uric acid and increased total cholesterol and triglycerides .
These effects were dose-related and were least for hydrochlorothiazide .
Chlorthalidone increased serum glucose but the evidence was unclear for other thiazides .
This systematic review shows that hydrochlorothiazide has a dose-related blood pressure-lowering effect .
Thiazides reduced potassium , increased uric acid and increased total cholesterol and triglycerides
BACKGROUND Hypertension is a modifiable cardiovascular risk factor .
Although it is established that low-dose thiazides reduce mortality as well as cardiovascular morbidity , the dose-related effect of thiazides in decreasing blood pressure has not been subject to a rigorous systematic review .
It is not known whether individual drugs within the thiazide diuretic class differ in their blood pressure-lowering effects and adverse effects .
OBJECTIVES To determine the dose-related decrease in systolic and /or diastolic blood pressure due to thiazide diuretics compared with placebo control in the treatment of patients with primary hypertension .
Secondary outcomes included the dose-related adverse events leading to patient withdrawal and adverse biochemical effects on serum potassium , uric acid , creatinine , glucose and lipids .
Use of Diuretics in Treatment of Hypertension in the Elderly
Summary Men and women with isolated systolic hypertension who were at least 60 years of age were treated for 1 year with chlorthalidone ( 25–50 mg daily ) or matching placebo as the step I drug . Most patients reached goal blood pressure without requiring a step II drug . The blood pressure response was similar in all age , sex and race subgroups , with an overall difference between the r and omised groups of 17 mm Hg for systolic blood pressure ( p<0.001 ) and 6 mm Hg for diastolic blood pressure ( p<0.001 ) . The only common adverse effects were asymptomatic changes in the serum concentrations of potassium ( 0.5 mmol/L lower in the chlorthalidone group , p<0.001 ) , uric acid ( 0.9 mg/dl higher , p<0.001 ) , and creatinine ( 0.08 mg/dl higher , p=0.02 . Compliance was good , and more than 80 % of participants were still taking the study medications at the end of the year . RésuméLes hommes et les femmes porteurs d’une hypertension systolique isolée , âgés au moins de 60 ans , ont été traités , en première intention , pendant 1 an avec du chlorthalidone ( 25–50 mg par jour ) ou par le traitement placebo apparié . La plupart des malades ont atteint la pression sanguine recherchée sans qu’il soit nécessaire de passer au degré II du traitement médicamenteux . La réponse de la pression sanguine a été similaire dans tous les sous-groupes âge , sexe et race , avec une différence extrême entre les groupes tirés au sort de 17 mmHg pour la pression systolique ( p<0.001 ) et 6 mmHg pour la pression diastolique ( p<0.001 ) . Les effets indésirables les plus fréquents ont été des changements asymptomatiques dans les concentrations sériques de potassium ( moins 0,5 mmol/l dans le groupe chlorthalidone , ( p<0.001 ) , d’acide urique ( plus 0,9 mg/dl , p<0.001 ) , et de créatinine ( plus 0,08 mg/dl , p=0.02 ) . L’adhésion au traitement a été bonne , et plus de 80 % des participants continuaient de prendre leurs médicaments à la fin de l’année de traitement . ZusammenfassungMänner und Frauen mit einer isolierten systolischen Hypertonie , die mindestens 60 Jahre alt waren , wurden über ein Jahr mit  Chlorthalidon ( 25–50 mg täglich ) oder gleichartigem Placebo als Pharmaka der ersten Stufe beh and elt . Die meisten Patienten erreichten den erwünschten Blutdruck , ohne daβ ein Medikament der zweiten Stufe erforderlich war . Die Blutdruck-Reaktion war in allen Alters- , Geschlechts-und Rassen-Untergruppen ähnlich mit einem Gesamtunterschied zwischen den r and omisierten Gruppen von 17 mmHg für den systolischen Blutdruck ( p<0,001 ) und 6 mmHg für den diastolischen Blutdruck ( p<0,001 ) . Die einzige gemeinsame Nebenwirkung best and in einer asymptomatischen Veränderung des Kalium in den Serumkonzentrationen ( 0,5 mmol/L niedriger in der Chlorthalidon-Gruppe , p<0,001 ) , Harnsäure ( 0,9 mg/dl höher , p<0,001 ) und Kreatinin ( 0,08 mg/dl höher , p=0,02 . Bei einer guten Compliance nahmen 80 % der Teilnehmer die Medikationen der Untersuchung noch am Ende des Jahres . ResumenHombres y mujeres con hipertensión sistólica aislada , que tenían por lo menos 60 años de edad , se han tratado durante 1 año con clortalidona ( 25–50 mg diarios ) , o placebo de análogo aspecto , como fármaco de etapa I. La mayoría de los pacientes alcanzaron la presión deseada sin necesitar medicamento de etapa II . La respuesta tensional fue semejante en todos los grupos de edad , sexo y raza con una diferencia total entre los grupos aleatorizados de 17 mm Hg para la presion sistólica ( p<0,001 ) y de 6 mm Hg para la diastólica ( p<0,001 ) . Los únicos efectos adversos de manifestación frecuente fueron modificaciones asintomáticas de las concentraciones séricas de potasio ( 0,5 mmol/l menos en el grupo clortalidona , p<0,001 ) , de ácido úrico ( 0,9 mg/dl mas , p<0,001 ) y de cretinina ( 0,08 mg/dl más , p=0,02 ) . La aceptación fue buena y más del 80 % de participantes todavía estaban tom and o las medicaciones en estudio al final del año . ResumoHomens e mulheres com hipertensão sistólica isolada e com idade mínima de 60 anos foram tratados por um ano com  clortalidona ( 25 a 50 mg por dia ) ou placebo  equivalente como drogas de primeira escolha . A maioria dos pacientes atingiu o nível de pressão sanguínea objetivado sem recorrerem a outras drogas . A reação da pressão sanguínea foi semelhante em todos os subgrupos , fossem por idade , sexo ou raça , com uma diferença global entre os grupos selecionados de 17 mmHg para a pressão sistólica ( p<0,001 ) e 6 mmHg para a pressão diastólica ( p<0,001 ) . Os únicos efeitos adversos comuns a todos foram mudanças assintomáticas nas concentrações de potássio no soro ( 0,5 mmol/L abaixo , no grupo com clortalidona , cortalidona , p<0,001 ) , no ácido ùrico ( 0,9 mg/dl acima , p<0,001 ) e na creatinina ( 0,08 mg/dl acima , p=0,02 ) . O indice de observância ao tratamento foi bom , sendo que mais de 80 % dos participantes ainda estavam a tomar os medicamentos empregados durante a experiência ao final do ano . RiassuntoSoggetti di entrambi i sessi di almeno 60 anni con ipertensione sistolica isolata furono trattati per un anno con clortalidone ( 25–50 mg al giorno ) o placebo , come farmaco di primo livello . La maggior parte dei pazienti normalizzarono la loro pressione arteriosa senza richiedere un farmaco di secondo livello . La risposta pressoria fu simile in tutti i sottogruppi di età , sesso e razza , con una differenza totale tra i gruppi r and omizzati di 17 mm Hg per la pressione sistolica ( p<0.001 ) e 6 mm Hg per la diastolica ( p<0.001 ) . I soli comuni effetti indesiderati furono modificazioni asintomatiche nette concentrazioni sieriche di potassio ( di 0,5 mmol/1 inferiore nel gruppo trattato con clortalidone , p < 0.001 ) , acido urico ( di 0.9 mg/dl più alto , p<0.001 ) e creatinina ( di 0.08 mg/dl maggiore , p<0.02 ) . La compliance fu buona e più dell’80 % dei partecipanti allo studio era ancora in trattamento alla fine dell’anno
Direct comparison of doses did not show evidence of dose dependence for blood pressure-lowering for any of the other thiazides for which RCT data were available : bendrofluazide , chlorthalidone , cyclopenthiazide , metolazone or indapamide .
This is based on an informal indirect comparison of results observed in other Cochrane review s on ACE inhibitors , ARBs and renin inhibitors compared with placebo , which used similar inclusion /exclusion criteria to the present review .Thiazides reduced potassium , increased uric acid and increased total cholesterol and triglycerides .
These effects were dose-related and were least for hydrochlorothiazide .
Chlorthalidone increased serum glucose but the evidence was unclear for other thiazides .
This systematic review shows that hydrochlorothiazide has a dose-related blood pressure-lowering effect .
Thiazides reduced potassium , increased uric acid and increased total cholesterol and triglycerides
BACKGROUND Hypertension is a modifiable cardiovascular risk factor .
Although it is established that low-dose thiazides reduce mortality as well as cardiovascular morbidity , the dose-related effect of thiazides in decreasing blood pressure has not been subject to a rigorous systematic review .
It is not known whether individual drugs within the thiazide diuretic class differ in their blood pressure-lowering effects and adverse effects .
OBJECTIVES To determine the dose-related decrease in systolic and /or diastolic blood pressure due to thiazide diuretics compared with placebo control in the treatment of patients with primary hypertension .
Secondary outcomes included the dose-related adverse events leading to patient withdrawal and adverse biochemical effects on serum potassium , uric acid , creatinine , glucose and lipids .