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 .
Pilot study of combined blockade of the renin–angiotensin system in essential hypertensive patients
Background Additive hemodynamic effects of combined blockade of the renin – angiotensin system by an angiotensin I converting enzyme inhibitor and an angiotensin II antagonist have been observed in sodium-depleted normotensive volunteers and in patients with congestive heart failure . Objective To investigate whether the same additive hemodynamic effects occur in patients with hypertension and to verify the safety of such an approach . Design Multicenter , r and omized , double-blind , parallel-group , pilot study . Patients 177 patients with mild-to-moderate hypertension [ diastolic blood pressure ( DBP ) : 95–115 mmHg after a 4-week placebo run-in period ] were included in the study . Intervention Combination therapy consisting of 50 mg losartan daily and 10 mg enalapril daily was administered for 6 weeks . The effects of this therapeutic regimen was compared with similar groups of patients who received either 50 mg losartan daily or 10 mg enalapril daily Main outcome measures 24-hour ambulatory mean DBP and clinic DBP measured at trough after 6 weeks of treatment . Results 24-hour ambulatory mean DBP did not significantly differ between treatment groups although the combination tended to lower BP more . The combination therapy was more effective on clinic DBP measured at trough than was losartan by 3.2 mmHg [ confidence interval ( 95 % , CI ) 0.7–5.7 mmHg , P = 0.012 ] , and more effective than enalapril by 4.0 mmHg ( 95 % CI , 1.5–6.4 mmHg , P = 0.002 ) . In a subgroup of 28 patients , higher plasma active renin and angiotensin I levels during blockade by the combination therapy were observed . This finding confirmed that the combination of the two agents inhibited the renin – angiotensin system to a greater extent than did either agent alone . Conclusion A combination of 10 mg enalapril daily and 50 mg losartan daily safely induces a supplementary , although modest , fall in clinic DBP in patients with mild-to-moderate essential hypertension
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 .