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 .
Double-blind, parallel, comparative multicentre study of a new combination of diltiazem and hydrochlorothiazide with individual components in patients with mild or moderate hypertension.
OBJECTIVE To compare the antihypertensive efficacy and tolerability of a new combination preparation of diltiazem ( 150 mg ) and hydrochlorothiazide ( 12.5 mg ) with the individual constituents in patients with mild/moderate hypertension . DESIGN Multi-centre , double-blind , r and omised parallel group study . PATIENTS Seventy-one patients with essential hypertension were recruited to the study . TREATMENT Following completion of the placebo run-in period 63 patients fulfilled the prer and omisation criteria and entered the 10 week treatment period . Patients were r and omised to receive either the combination preparation ( D 150 mg/H 12.5 mg ) , diltiazem ( 150 mg ) or hydrochlorthiazide ( 12.5 mg ) . The dosage was increased in three patients who had not attained target blood pressure ( BP ) control after 6 weeks . OUTCOME MEASURES Response to treatment assessed by change from baseline in clinic and 24 h ambulatory BP . RESULTS The proportion of patients achieving target BP ( a reduction in resting supine diastolic blood pressure ( DBP ) to below 90 mm Hg or a reduction of 10 mm Hg from baseline ) was 80 % in the combination group , 55 % in the diltiazem group , and 38 % in the hydrochlorothiazide group . The respective figures for reduction in supine DBP from baseline were 13.5 mm Hg , 11.2 mm Hg and 5.9 mm Hg . A similar treatment order appeared throughout each of the efficacy variables . BP control throughout the 24 h dosing interval was demonstrated by ambulatory BP monitoring . Each treatment was well tolerated . CONCLUSION This study provides clear evidence of the efficacy of combination therapy with diltiazem and hydrochlorothiazide in the management of patients with hypertension
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 .