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 .
Effectiveness of enalapril in combination with low-dose hydrochlorothiazide versus enalapril alone for mild to moderate systemic hypertension in black patients.
The importance of concomitant low-dose hydrochlorothiazide was assessed in black hypertensive patients treated with enalapril .  Left ventricular ( LV ) mass and function , metabolic parameters , 24-hour ambulatory blood pressure ( BP ) , exercise duration , and systolic BP response were evaluated before and after drug therapy . Enalapril 20 mg ( group 1 ) or enalapril 20 mg plus hydrochlorothiazide 12.5 mg ( single tablet ; group 2 ) was given to 38 patients for 9 weeks in a double-blind , placebo-controlled , r and omized study . LV mass measured 61 + /- 17 versus 102 + /- 23 g/m2 , and 24-hour ambulatory BP measured 120 + /- 8/75 + /- 6 versus 155 + /- 12/100 + /- 6 mm Hg in matched control subjects ( n = 40 ) versus hypertensive patients , respectively . No clinical ly important changes occurred in total cholesterol , serum uric acid or potassium in either group . Enalapril slightly reduced 24-hour ambulatory BP from 154 + /- 15/100 + /- 7 mm Hg to 148 + /- 19/96 + /- 11 mm Hg after treatment ( p < 0.05 for systolic BP ) ; systolic BP load ( 70 % to 59 % , p < 0.05 ) , and diastolic BP load ( 67 % to 60 % , p = NS ) decreased . Baseline BP decreased from 157 + /- 9/101 + /- 6 to 132 + /- 13/86 + /- 8 mm Hg ( p < 0.0001 ) ; systolic BP load ( 64 % to 29 % , p < 0.0001 ) , and diastolic BP load ( 64 % to 33 % , p < 0.0001 ) decreased in group 2 . Exercise systolic BP was attenuated ( p = 0.007 , group 2 ; p = NS , group 1 ) and duration increased ( p = NS ) only in group 2 . ( ABSTRACT TRUNCATED AT 250 WORDS
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 .