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 .
Antihypertensive efficacy and tolerability of two fixed-dose combinations of valsartan and hydrochlorothiazide compared with valsartan monotherapy in patients with stage 2 or 3 systolic hypertension: an 8-week, randomized, double-blind, parallel-group trial.
BACKGROUND Combination therapy with at least 2 antihypertensive agents is usually needed to achieve appropriate blood pressure ( BP ) control in patients with isolated or predominant systolic hypertension . A currently recommended combination is a diuretic added to an angiotensin-receptor blocker . OBJECTIVE This was a study of the effects on sitting systolic BP (SBP)of 2 combinations of valsartan and hydrochlorothiazide ( HCTZ ) compared with valsartan monotherapy in patients with stage 2 or 3 systolic hypertension ( SBP > or = 160 mm Hg and < or = 200 mm Hg ) with or without other cardiovascular risk factors . METHODS After a placebo run-in period , patients were r and omized to receive double-blind treatment with either valsartan 80 mg OD(monotherapy group ) or valsartan 160 mg OD ( combination-therapy groups ) for 4 weeks , followed by forced titration to valsartan 160 mg OD ( V160 ) , valsartan 160 mg plus HCTZ 12.5 mg OD ( V160 + HCTZ12.5 ) , or valsartan 160 mg plus HCTZ 25 mg OD ( V160 + HCTZ25 ) for an additional 4 weeks . End points were the change in SBP between the groups receiving combination therapy and the monotherapy group , between-group changes in diastolic BP ( DBP ) , responder rates ( SBP < 140 mm Hg or a reduction in SBP of > or = 20 mm Hg ) , and tolerability . RESULTS A total of 774 patients were r and omized to treatment : 261 to V160 , 258 to V160+HCTZ12.5 , and 255 to V160 + HCTZ25 . The intent-to-treat population consisted of 767 patients ( 411 men , 356 women ; mean age , 60 years ; mean weight , 84 kg ; clinic mean [ SD ] baseline BP , 167.5 [8.1]/93.4 [ 9.1 ] mm Hg ) . All treatments produced significant reductions in SBP from baseline ( mean [ SD ] reduction , 20.7 [ 15.7 ] mm Hg with V160 , 27.9 [ 13.8 ] mm Hg with V160 + HCTZ12.5 , and 28.3 [ 13.1 ] mm Hg with V160+HCTZ25 ; all , P < 0.05 ) . DBP was reduced by 6.6 ( 8.9 ) mm Hg in the V160 group and by 10.2 ( 7.7 ) and 10.1 ( 7.8 ) mm Hg in the V160+HCTZ12.5 and V160 + HCTZ25 groups , respectively ( all , P < 0.05 ) . The additional reductions in BP with V160+HCTZ25 did not reach statistical significance compared with V160+HCTZ12.5 . Responder rates were 56.9 % in the V160 group , 74.4 % in the V160+HCTZ12.5 group , and 75.0 % in the V160 + HCTZ25 group P < 0.05 , combination therapy vs monotherapy ) . Adverse events were reported by 27.5 % of patients in the monotherapy group , compared with 28.6 % and 34.0 % in the groups that received V160+HCTZ12.5 and V160+HCTZ25 , respectively ; the differences were not significant between treatment groups . CONCLUSIONS Monotherapy with V160 was effective in these patients with stage 2 or 3 systolic hypertension . Significant additional reductions in SBP and DBP and an increase in responder rates were achieved with the addition to V160 of HCTZ12.5 and HCTZ25 , with no significant effect on tolerability
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 .