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 verapamil and trandolapril in the treatment of hypertension. Trandolapril Study Group.
The combination of an angiotensin converting enzyme inhibitor with a calcium antagonist has become a common way of treating patients with essential hypertension who respond insufficiently to monotherapy . This double-blind , r and omized , parallel , placebo-controlled , multicenter , outpatient study evaluated the antihypertensive efficacy and safety of a calcium antagonist ( verapamil SR ) and an angiotensin converting enzyme inhibitor ( tr and olapril ) in patients with mild-to-moderate ( stages I and II ) essential hypertension . Six hundred thirty-one patients were enrolled in this 10-week study . After a 4-week single-blind placebo phase , patients received one of the following daily dosage regimens in a double-blind fashion for 6 weeks : placebo , 4 mg of tr and olapril , 240 mg of verapamil SR , or a combination of 4 mg of tr and olapril and 240 mg of verapamil SR .  Trough sitting diastolic blood pressure was lowered by 4.5 mm Hg , 4.3 mm Hg , and 8.1 mm Hg more than placebo in the tr and olapril , verapamil SR , and combination groups , respectively . In the combination group , sitting diastolic blood pressure was significantly lowered ( P < .01 ) by 3.6 mm Hg more than in the tr and olapril group and by 3.8 mm Hg more than in the verapamil SR group . An analysis of the trough-to-peak ratio for sitting diastolic blood pressure revealed values of 0.75 and 0.67 , for the 4-mg tr and olapril and the combination groups , respectively , at end point . The overall incidence of adverse reactions was similar for all treatment groups . In this study the combination of an angiotensin converting enzyme inhibitor and calcium antagonist was well tolerated and more effective than either agent administered alone for the treatment of 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 .