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 .
Controlled Multicenter Study with Quinapril, Hydrochlorothiazide, and Combination in Patients with Moderate to Severe Hypertension
Summary : In an 8-week , double-blind , r and omized , active-controlled , multicenter study with three parallel treatment groups , we compared the efficacy and safety of once-daily 20 mg quinapril plus 12.5 mg hydrochlorothi-azide ( HCTZ ) with each drug as monotherapy in patients with moderate to severe hypertension . Hypertensive out patients with supine diastolic blood pressure ( DBF ) ≤105 and ≥120 mm Hg at the end of a 2− to 4-week placebo-baseline period were r and omly assigned to one of the treatment groups . Of the 323 patients who were r and omized to double-blind medication , 297 completed the study , but 6 patients were excluded for violations of protocol ; therefore , statistical analysis was performed in 291 patients . Only 7 patients withdrew owing to lack of efficacy ( 2 receiving combination therapy ) . In all three treatment groups , clinical ly significant reductions in DBF were achieved . Combination therapy was statistically more effective than each component in both evaluable data and intent-to-treat analyses . The incidence of adverse events ( AE ) was 24 % in the quinapril monotherapy group , 14 % in the combination therapy group , and 11 % in the HCTZ monotherapy group . Orthostatic hypotension with related symptoms was observed in 4 patients ( 2 receiving quinapril monotherapy , 1 receiving HCTZ monotherapy , and 1 receiving combination therapy ) . Once-daily quinapril plus HCTZ provided increased reduction of DBF as compared with the monotherapies and was well tolerated in patients with moderate to severe 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 .