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 .
Felodipine, metoprolol and their combination compared with placebo in isolated systolic hypertension in the elderly.
This study compared with placebo the efficacy and tolerability of optimised doses of felodipine 5 - 20 mg daily , metoprolol 50 - 200 mg daily and their combination in subjects 60 years or over with isolated systolic hypertension . The study employed a r and omised double-blind crossover design with allocation of treatment order within subjects by Latin squares . For each subject , after a single-blind run-in placebo phase , there were four r and omised treatment phases each of six weeks duration , with a dose titration step at three weeks if necessary . Twenty-eight subjects entered the r and omised phases of the study and twenty-one completed all four phases--13 male , 8 female ( ages : median 71 , range 59 - 85 years ) . At the end of both the felodipine and metoprolol phases systolic and diastolic pressure were reduced at 2 hours postdose compared with the placebo phase ( p < 0.001 ) , the blood pressure reduction with felodipine ( -40/-20 mmHg ) being greater than that with metoprolol ( -15/-9 mmHg ) ( p < 0.01 ) . Immediately predose ( 12 hours postdose ) there was a persisting reduction of supine systolic blood pressure ( -17 mmHg ) with felodipine ( p < 0.001 ) , but there was no significant effect of metoprolol . At both measurement times the two drugs when in combination had an additive effect on blood pressure . There was a 20 % increase in reported symptoms during each of the active treatment phases . Four subjects withdrew during the r and omised phases because of probable drug-related adverse events and six subjects required dosage reductions during the felodipine or combination phases . ( ABSTRACT TRUNCATED AT 250 WORDS
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 .