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 .
Lack of agreement between office and ambulatory blood pressure responses to hydrochlorothiazide.
BACKGROUND Differences between the antihypertensive responses to drug therapy measured by office blood pressure ( OBP ) and ambulatory blood pressure monitoring ( ABPM ) techniques have been noted but rarely analyzed . We studied whether the OBP and 24-h ABPM responses to hydrochlorothiazide differ and , if so , the relevance of these differences . METHODS The  OBP and ABPM responses to hydrochlorothiazide ( 25 mg/d , for 4 weeks ) were measured in 228 subjects with essential hypertension , and mean responses were compared between methods using the Student paired t test . To assess variation in the agreement between OBP and ABPM responses among subjects , the limits of agreement were calculated as the mean difference between OBP and ABPM responses + /-2 st and ard deviations . RESULTS The mean systolic OBP response was 4.8 mm Hg greater than the response measured by ABPM ( -14.3 v -9.5 mm Hg , P < .001 ) , and the mean diastolic OBP response was 2.1 mm Hg greater than the response measured by ABPM ( -7.5 v -5.5 , P < .001 ) . The limits of agreement between the OBP and ABPM responses ranged from -18.7 to + 28.2 mm Hg for systolic response and from -12.9 to + 17.1 mm Hg for diastolic response . The systolic and diastolic OBP and ABPM responses were in opposite directions in 22.8 % and 23.7 % of the subjects , respectively . CONCLUSIONS Compared to ABPM , OBP overestimates the mean systolic and mean diastolic blood pressure responses to hydrochlorothiazide . Variation among subjects in the magnitude and direction of responses renders OBP an unreliable predictor of ABPM responses
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 .