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 .
A comparison of the efficacy and safety of irbesartan/HCTZ combination therapy with irbesartan and HCTZ monotherapy in the treatment of moderate hypertension
This prospect i ve , double-blind , parallel-group study r and omized patients with moderate hypertension ( seated systolic blood pressure ( SeSBP ) 160–179 mm Hg when seated diastolic blood pressure ( SeDBP ) < 110 mm Hg ; or SeDBP 100–109 mm Hg when SeSBP < 180 mm Hg ) 3:1:1 to treatment with irbesartan 300 mg/hydrochlorothiazide ( HCTZ ) 25 mg combination therapy  ( n=328 ) , irbesartan 300 mg monotherapy ( n=106 ) or HCTZ monotherapy 25 mg ( n=104 ) . Treatment was initiated at half dose , with forced titration to full dose after two weeks followed by ten further weeks ' treatment . The primary efficacy variable was the mean reduction in SeSBP from baseline to week 8 . Baseline characteristics were similar between groups , with mean baseline blood pressure approximately 162/98 mm Hg ; the mean age was 55 years . At week 8 there was a reduction in SeSBP of 27.1 mm Hg with irbesartan/HCTZ , compared with 22.1 mm Hg with irbesartan monotherapy ( P=0.0016 ) and 15.7 mm Hg with HCTZ ( P<0.0001 ) . Both the rate of decline and the total degree of decline achieved were greatest with irbesartan/HCTZ and least with HCTZ . A significantly greater percentage of patients reached a treatment goal of SeSBP < 140 mm Hg and SeDBP < 90 mm Hg by week 8 with irbesartan/HCTZ ( 53.4 % ) , compared with irbesartan ( 40.6 % ; P=0.0254 ) and HCTZ ( 20.2 % ; P<0.0001 ) alone . Treatment was well tolerated in all three-treatment groups with a slight increase in adverse events in the combination therapy group . In conclusion , irbesartan/HCTZ ( 300/25 mg ) is well tolerated and achieves rapid and sustained reductions in both systolic blood pressure and diastolic blood pressure in patients with moderate 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 .