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 candesartan, felodipine, and their combination in the treatment of elderly patients with systolic hypertension.
Monotherapy frequently does not cause adequate blood pressure ( BP ) reduction and goal BP is not achieved . This double-blind , r and omized , crossover , placebo-controlled study investigated , using a factorial design , the interaction between a dihydropyridine calcium channel blocking drug ( felodipine 5 mg ) and an angiotensin type I receptor blocking drug ( c and esartan 16 mg ) on the control of BP as assessed by 24-h ambulatory monitoring . A total of 31 elderly patients with systolic hypertension completed all four arms of the study . C and esartan and felodipine lowered mean 24-h BP to a similar extent ( c and esartan 12.2 + /- 2.6/7.5 + /- 1.8 ; felodipine 11.9 + /- 2.2/5.7 + /- 1.4 mm Hg ) . The combination lowered it by 21.0 + /- 2.1/11.2 + /- 1.2 mm Hg , and this fall was significantly greater than with either of the monotherapies ( P < .005 ) and was fully additive with no interactive term . The responder rate with the combination ( 90 % ) was greater than with c and esartan ( 61 % ) or felodipine ( 55 % ) . Microalbuminuria or proteinuria was present in 12 of 31 patients at r and omization despite previous BP control . C and esartan and the combination both reduced urinary albumin excretion . Albumin excretion was not reduced by felodipine despite BP control similar to that achieved with c and esartan .  Side effects were infrequent and were fewer on the combination than on placebo or on the monotherapies . The combination of felodipine 5 mg and c and esartan 16 mg has additive effects on BP in elderly patients with systolic hypertension . The combination was well tolerated and is suitable for use in patients who do not have an adequate response to monotherapy
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 .