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 .
Enalapril, hydrochlorothiazide, and combination therapy in patients with moderate hypertension.
Using a placebo baseline , positive controlled , double-blind , r and omized titration to effect our study protocol , we assessed the antihypertensive actions of enalapril , hydrochlorothiazide , and their combination in 37 patients with moderate essential hypertension . Patients were maintained on their regular diets and received a placebo for 4 weeks . Patients with moderate systemic hypertension were r and omized to receive enalapril monotherapy at a dose of 10 mg twice daily ( n = 16 ) , hydrochlorothiazide monotherapy at a dose of 25 mg twice daily ( n = 15 ) , or combination therapy consisting of 10 mg enalapril and 25 mg hydrochlorothiazide twice daily ( n = 6 ) . Therapy could be titrated to twice the starting dose . All treatment regimens reduced blood pressure , but only one patient had blood pressure normalized ( diastolic blood pressure less than or equal to 90 mmHg ) with enalapril ( 7 % ) , two patients with hydrochlorothiazide ( 15 % ) , and 80 % of patients with combination therapy . The patients who had not achieved normal blood pressure received combination treatment , and after 8 additional weeks , more than 70 % showed normal blood pressure . After one year of combination therapy , 92 % of the patients continue to have normal blood pressure . Both the monotherapy and combination regimens were very well tolerated in this study . In conclusion , enalapril , hydrochlorothiazide , and their combination are effective in reducing blood pressure in patients with moderate hypertension . However , monotherapy is successful in normalizing blood pressure only in a small percentage of patients . Combination therapy achieved normalization of blood pressure in almost all patients , suggesting that most patients on regular diets with moderate hypertension may require a diuretic-ACE inhibitor combination rather than monotherapy to achieve effective blood pressure control
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 .