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 .
Ambulatory Blood Pressure Profiles in Patients Treated with Once-Daily Diltiazem Extended-Release or Indapamide Alone or in Combination
& NA ; This r and omized , double-blind , placebo-controlled , parallel-group study evaluated the efficacy and safety of single daily dose diltiazem extended-release ( XR ) and indapamide , given alone and combined , in 255 male and 170 female patients with mild to moderate hypertension .  Blood pressure was assessed both manually in the office and by 24-hour ambulatory blood pressure monitoring ( ABPM ) techniques . Between-treatment efficacy comparisons were based on ABPM plots and changes from baseline in supine systolic ( SuSBP ) and diastolic ( SuDBP ) blood pressure after 6 weeks of doubleblind treatment . Periodic 12-lead electrocardiograms ( ECG ) , clinical laboratory tests , and physical examinations were used to assess safety . Both diltiazem XR 180 , 240 , and 360 mg and indapamide 2.5 mg monotherapy reduced ambulatory blood pressure to a greater extent than placebo . The ABPM data demonstrate that 2.5 mg indapamide produces an additional reduction in diastolic blood pressure when combined with fixed doses of diltiazem XR ( 120 , 180 , and 240 mg ) . The reduction was consistent over the entire 24-hour recording period for all combinations . Compared with monotherapy groups , higher therapeutic response rates ( SuDBP ≤ 90 mm Hg or & Dgr ; SuDBP ≥ 10 mm Hg decrease from baseline ) were also observed with combination therapy . Office blood pressure data qualitatively and quantitatively supported the observations made from the ABPM data . There were no unexpected adverse events or side-effect trends and no dose-response or clinical ly significant laboratory , ECG , or physical examination adverse effects . The combination therapy regimens were well tolerated with safety profiles comparable with those of the individual therapies
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 .