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 .
Expedited blood pressure control with initial angiotensin II antagonist/diuretic therapy compared with stepped-care therapy in patients with ambulatory systolic hypertension.
OBJECTIVES The present study investigated whether initiating therapy with a combination of losartan ( L ) and hydrochlorothiazide ( HCTZ ) allows for faster blood pressure ( BP ) control and fewer medications than the usual stepped-care approach in patients with stage 2 or 3 hypertension and ambulatory systolic hypertension . METHODS Patients with a mean daytime systolic ambulatory BP ( ABP ) of 135 mmHg or higher were r and omly assigned to receive L 50 mg plus HCTZ 12.5 mg titrated to L 100 mg plus HCTZ 25 mg versus HCTZ 12.5 mg plus atenolol 50 mg . Amlodipine 5 mg was then added , if needed , to achieve a  BP goal of less than 130 mmHg . Treatment titration was based on ABP . RESULTS Significantly more patients r and omly assigned to L/HCTZ ( 63.5 % ) than stepped-care ( 37.5 % ; P=0.008 ) achieved the primary end point ( daytime systolic BP of less than 130 mmHg ) . Initial L/HCTZ induced significantly greater decreases in ABP during each 24 h period after six weeks of therapy . Although reductions in systolic and diastolic ABP were not statistically different at the end of the study , ABP reduction was significantly greater ( P<0.001 ) with the L/HCTZ-based regimen . Twice as many patients in the L/HCTZ group achieved the goal ABP with no more than two drugs ( 30.0 % versus 14.7 % ; P=0.03 ) . Moreover , tolerability was significantly better ( P=0.006 ) in the L/HCTZ group , with a 40.0 % incidence of adverse events , versus 65.6 % in the stepped-care group . CONCLUSION Initiating antihypertensive therapy with the combination of L/HCTZ in patients with stage 2 or 3 hypertension and ambulatory systolic hypertension reaches a target BP faster in a higher proportion of patients , with fewer adverse events and less need for a third drug regimen than the conventional stepped-care approach
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 .