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 .
Effects of enalapril and hydrochlorothiazide on blood pressure, renin-angiotensin system, and atrial natriuretic factor in essential hypertension: a double blind factorial cross-over study.
The hypotensive and hormonal effects of the angiotensin converting enzyme ( ACE ) inhibitor enalapril ( 10 mg twice daily ) were compared with those of hydrochlorothiazide ( 25 mg twice daily ) , with the two drugs in combination and with placebo in 21 patients with essential hypertension . For each patient there were four r and omised double-blind treatment phases , each of four weeks ' duration , which comprised a 2 X 2 factorial experiment . All blood pressure parameters were reduced in the three active treatment phases compared to placebo ( p less than 0.001 ) . Supine mean blood pressures were 119 mmHg ( placebo ) , 113 mmHg ( hydrochlorothiazide ) , 108 mmHg ( enalapril ) , and 98 mmHg ( hydrochlorothiazide plus enalapril ) ( SEM 3 mmHg , ANOVA ) . Enalapril and hydrochlorothiazide were equally effective and well tolerated and their hypotensive effects were additive . Enalapril increased plasma renin activity ( PRA ) , reduced plasma angiotensin II ( AII ) and aldosterone concentrations , and reduced ACE activity , whereas hydrochlorothiazide increased PRA , plasma AII , and aldosterone concentrations without altering ACE activity . With combination treatment the effects of enalapril on PRA and plasma AII concentrations were potentiated whereas those on plasma aldosterone concentration and ACE activity were additive . Atrial natriuretic factor plasma concentration in the placebo phase was 92 pg/ml and increased to 145 pg/ml in the hydrochlorothiazide phase ( p less than 0.001 , SEM 13 pg/ml ) , but there was no significant change in either the enalapril or combination phases
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 .