The antihypertensive efficacy of HCTZ in its daily dose of 12.5 to 25 mg as measured in head-to-head studies by ambulatory BP measurement is consistently inferior to that of all other drug classes .
Because outcome data at this dose are lacking , HCTZ is an inappropriate first-line drug for the treatment of hypertension
OBJECTIVES The purpose of this study was to evaluate the antihypertensive efficacy of hydrochlorothiazide ( HCTZ ) by ambulatory blood pressure ( BP ) monitoring .
BACKGROUND HCTZ is the most commonly prescribed antihypertensive drug worldwide .
More than 97 % of all HCTZ prescriptions are for 12.5 to 25 mg per day .
The antihypertensive efficacy of HCTZ by ambulatory BP monitoring is less well defined .
Mortality after 10 1/2 years for hypertensive participants in the Multiple Risk Factor Intervention Trial.
The Multiple Risk Factor Intervention Trial ( MRFIT ) is a r and omized primary prevention trial that tested the effect of a multifactor intervention program on coronary heart disease ( CHD ) mortality in 12,866 high-risk men aged 35 - 57 years . Men were r and omly assigned to either a special intervention ( SI ) program , which consisted of dietary advice for lowering blood cholesterol levels , counseling aim ed at cessation for cigarette smokers , and stepped-care treatment for hypertension for those with elevated blood pressure , or to their usual sources of health care within the community ( UC ) . Among the 12,866 r and omized men , 8,012 ( 62 % ) were hypertensive at baseline . For this subgroup , mortality rates with 10.5 years of follow-up were lower for the SI than for the UC group by 15 % ( p = 0.19 ) for CHD and 11 % ( p = 0.13 ) for all causes . These results reflected more favorable outcomes for SI compared with UC hypertensive men during the 3.8 posttrial years ( March 1982 through December 1985 ) than during the preceding 6 - 8 years ( through February 1982 ) . During the posttrial years , death rates were lower for SI than for UC men by 26 % ( p = 0.09 ) for CHD and 23 % ( p = 0.02 ) for all causes . For those with diastolic blood pressure equal to or more than 100 mm Hg , this posttrial trend was a continuation of a trend during the trial ; therefore , with 10.5 years of follow-up , death rates were markedly lower for SI than for UC by 36 % ( p = 0.07 ) for CHD and 50 % ( p = 0.0001 ) for all causes . Similarly , for those without baseline resting electrocardiographic abnormalities , the favorable posttrial outcome for the SI group was a continuation of a trend during the trial . In contrast , for those with baseline diastolic blood pressure of 90 - 99 mm Hg and for those with baseline resting electrocardiographic abnormalities , the favorable posttrial mortality findings for the SI group were a reversal of unfavorable trends recorded during the trial . Two factors appear to have contributed to this more favorable mortality trend for the SI group : 1 ) a change in the diuretic treatment protocol for SI men about 5 years after r and omization , which involved replacement of hydrochlorothiazide with chlorthalidone at a daily maximum dose of 50 mg ; and 2 ) a favorable effect of intervention on nonfatal cardiovascular events during the trial years . In addition , delay until the full impact of beneficial effects on mortality end points from smoking cessation and cholesterol lowering could have contributed . ( ABSTRACT TRUNCATED AT 400 WORDS
The antihypertensive efficacy of HCTZ in its daily dose of 12.5 to 25 mg as measured in head-to-head studies by ambulatory BP measurement is consistently inferior to that of all other drug classes .
Because outcome data at this dose are lacking , HCTZ is an inappropriate first-line drug for the treatment of hypertension
OBJECTIVES The purpose of this study was to evaluate the antihypertensive efficacy of hydrochlorothiazide ( HCTZ ) by ambulatory blood pressure ( BP ) monitoring .
BACKGROUND HCTZ is the most commonly prescribed antihypertensive drug worldwide .
More than 97 % of all HCTZ prescriptions are for 12.5 to 25 mg per day .
The antihypertensive efficacy of HCTZ by ambulatory BP monitoring is less well defined .