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 .
Efficacy of different drug classes used to initiate antihypertensive treatment in black subjects: results of a randomized trial in Johannesburg, South Africa.
BACKGROUND Thiazides are recommended to initiate antihypertensive drug treatment in black subjects . OBJECTIVE To test the efficacy of this recommendation in a South African black cohort . METHODS Men and women ( N = 409 ) , aged 18 to 70 years , with a mean ambulatory daytime diastolic blood pressure between 90 and 114 mm Hg , were r and omized to 13 months of open-label treatment starting with the nifedipine gastrointestinal therapeutic system ( 30 mg/d , n = 233 ) , sustained-release verapamil hydrochloride ( 240 mg/d , n = 58 ) , hydrochlorothiazide ( 12.5 mg/d , n = 58 ) , or enalapril maleate ( 10 mg/d , n = 60 ) . If the target of reducing daytime diastolic blood pressure below 90 mm Hg was not attained , the first-line drugs were titrated up and after 2 months other medications were added to the regimen . RESULTS While receiving monotherapy ( 2 months , n = 366 ) , the patients ' systolic and diastolic decreases in daytime blood pressure averaged 22/14 mm Hg for nifedipine , 17/11 mm Hg for verapamil , 12/8 mm Hg for hydrochlorothiazide , and 5/3 mm Hg for enalapril . At 2 months the blood pressure of more patients treated with nifedipine was controlled : 133 ( 63.3 % , P</=.03 ) vs 20 ( 39.9 % ) receiving verapamil , 21 ( 40.4 % ) receiving hydrochlorothiazide , and 11 ( 20.8 % ) receiving enalapril . At 13 months ( n = 257 ) , more patients ( P<.001 ) continued receiving monotherapy with nifedipine ( 94/154 [ 61.0 % ] ) or verapamil ( 22/35 [ 62.9 % ] ) than hydrochlorothiazide ( 10/39 [ 25.6 % ] ) or enalapril ( 1/29 [ 3.4 % ] ) . A sustained decrease of left ventricular mass ( P<.001 ) with no between-group differences was achieved at 4 and 13 months . CONCLUSIONS In contrast to current recommendations , calcium channel blockers are more effective than thiazides as initial treatment in black subjects with hypertension . If treatment is started with thiazides or converting-enzyme inhibitors , combination therapy is more likely to be required to control blood pressure and reduce left ventricular mass
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 .