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 .
Comparison of five antihypertensive monotherapies and placebo for change in left ventricular mass in patients receiving nutritional-hygienic therapy in the Treatment of Mild Hypertension Study (TOMHS).
BACKGROUND Increased left ventricular mass ( LVM ) by echocardiography is associated with increased risk of cardiovascular disease . Thus , it is of interest to compare the effects of both pharmacological and nonpharmacological approaches to the treatment of hypertension on reduction of LVM . METHODS AND RESULTS Changes in LV structure were assessed by M-mode echocardiograms in a double-blind , placebo-controlled clinical trial of 844 mild hypertensive participants r and omized to nutritional-hygienic ( NH ) intervention plus placebo or NH plus one of five classes of antihypertensive agents : ( 1 ) diuretic ( chlorthalidone ) , ( 2 ) beta-blocker ( acebutolol ) , ( 3 ) alpha-antagonist ( doxazosin mesylate ) , ( 4 ) calcium antagonist ( amlodipine maleate ) , or ( 5 ) angiotensin-converting enzyme inhibitor ( enalapril maleate ) . Echocardiograms were performed at baseline , at 3 months , and annually for 4 years . Changes in blood pressure averaged 16/12 mm Hg in the active treatment groups and 9/9 mm Hg in the NH only group . All groups showed significant decreases ( 10 % to 15 % ) in LVM from baseline that appeared at 3 months and continued for 48 months . The chlorthalidone group experienced the greatest decrease at each follow-up visit ( average decrease , 34 g ) , although the differences from other groups were modest ( average decrease among 5 other groups , 24 to 27 g ) . Participants r and omized to NH intervention only had mean changes in LVM similar to those in the participants r and omized to NH intervention plus pharmacological treatment . The greatest difference between groups was seen at 12 months , with mean decreases ranging from 35 g ( chlorthalidone group ) to 17 g ( acebutolol group ) ( P = .001 comparing all groups ) . Within-group analysis showed that changes in weight , urinary sodium excretion , and systolic BP were moderately correlated with changes in LVM , being statistically significant in most analyses . CONCLUSIONS NH intervention with emphasis on weight loss and reduction of dietary sodium is as effective as NH intervention plus pharmacological treatment in reducing echocardiographically determined LVM , despite a smaller decrease in blood pressure in the NH intervention only group . A possible exception is that the addition of diuretic ( chlorthalidone ) may have a modest additional effect on reducing LVM
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 .