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 .
Comparison of effects of captopril used either alone or in combination with a thiazide diuretic on insulin action in hypertensive Type 2 diabetic patients: a double-blind crossover study.
AIMS It has been suggested that the adverse metabolic effects of antihypertensive therapy offset some of the benefits of blood pressure reduction . It has also been suggested that angiotensin converting enzyme ( ACE ) inhibitors reduce insulin resistance and that , if used together with thiazide diuretics , the adverse effects of thiazides on insulin sensitivity may be eliminated . We examined the effects on insulin sensitivity of captopril either alone or in combination with bendrofluazide in 11 hypertensive Type 2 diabetic patients . METHODS Insulin action was assessed using an isoglycaemic hyperinsulinaemic clamp in a double-blind , r and omized , crossover study after a 6-week placebo run-in and following two 12-week treatment periods with captopril ( C ) ( 100 mg ) alone or in combination with bendrofluazide ( CB ) ( 2.5 mg ) . RESULTS Blood pressure was lower following CB compared to C ( 128/82 vs. 144/ 88 mmHg ; P<0.005 ) and both were lower than baseline ( 162/101 mmHg ; P < 0.001 ) . CB result ed in a significant increase in fasting plasma glucose compared to C ( 9.7+/-0.8 vs. 8.5+/-0.6 mmol/ ; P < 0.05 ) . Exogenous glucose infusion rates required to maintain isoglycaemia during hyperinsulinaemia were lower after CB compared to C ( 22.3+/-2.4 vs. 27.4+/-4.2 mol x kg(-1 ) x min(-1 ) ; P < 0.05 ) . Suppression of endogenous glucose production was reduced after CB compared to baseline ( 4.0+/-0.6 vs. 2.4+/-0.5 mol x kg(-1 ) x min(-1 ) ; P < 0.05 ) . CONCLUSIONS Combination of bendrofluazide with captopril lowered blood pressure but result ed in deleterious effects on insulin action compared to captopril alone
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 .