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 .
Diuretics, serum and intracellular electrolyte levels, and ventricular arrhythmias in hypertensive men.
OBJECTIVE To investigate the patterns of electrolyte abnormalities result ing from thiazide administration and whether they cause ventricular arrhythmias , and to help resolve the controversy over whether clinicians should routinely prescribe potassium-conserving therapy to all patients treated with thiazides .  DESIGN Double-blind , r and omized controlled trial . PARTICIPANTS A total of 233 hypertensive men aged 35 to 70 years . INTERVENTIONS Participants were withdrawn from prior diuretic treatment and were replenished with oral potassium chloride and magnesium oxide . They were then r and omized to 2 months of treatment with ( 1 ) hydrochlorothiazide ; ( 2 ) hydrochlorothiazide with oral potassium ; ( 3 ) hydrochlorothiazide with oral potassium and magnesium ; ( 4 ) hydrochlorothiazide and triamterene ; ( 5 ) chlorthalidone ; or ( 6 ) placebo . MAIN OUTCOME MEASURES Ventricular arrhythmias on 24-hour Holter monitoring and serum and intracellular potassium and magnesium levels . RESULTS Of the 233 participants , 212 ( 91 % ) completed the study .  Serum potassium levels were 0.4 mmol/L lower in the hydrochlorothiazide group than in the placebo group ( P less than 0.01 ) , and this mean difference was not affected by supplementation with potassium , with potassium and magnesium , or with triamterene . However , the supplements did prevent the occasional occurrence of marked hypokalemia ; all 12 of the men who developed serum potassium levels of 3.0 mmol/L or less were among the 90 who received diuretics without supplementation ( P less than 0.01 ) . Similarly , the overall proportion of men with ventricular arrhythmias was not affected by r and omized treatment , but there was a twofold increase in the proportion with arrhythmias among the 12 men with serum potassium levels of 3.0 mmol/L or less ( P = .02 ) . Serum magnesium and intracellular potassium and magnesium levels were not reduced by hydrochlorothiazide , nor were they related to ventricular arrhythmias . CONCLUSIONS In the majority of hypertensive patients , treatment with 50 mg/d of hydrochlorothiazide does not cause marked hypokalemia or ventricular arrhythmias . However , because some individuals will develop hypokalemia after starting diuretic therapy , serum potassium levels should be monitored and potassium-sparing strategies should be used when indicated
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 .