Blood pressure-lowering efficacy of monotherapy with thiazide diuretics for primary hypertension

Abstract

This systematic review shows that hydrochlorothiazide has a dose-related blood pressure-lowering effect. The mean blood pressure-lowering effect over the dose range 6.25 mg, 12.5 mg, 25 mg and 50 mg/day is 4/2 mmHg, 6/3 mmHg, 8/3 mmHg and 11/5 mmHg, respectively. For other thiazide drugs, the lowest doses studied lowered blood pressure maximally and higher doses did not lower it more. Due to the greater effect on systolic than on diastolic blood pressure, thiazides lower pulse pressure by 4 mmHg to 6 mmHg. This exceeds the mean 3 mmHg pulse pressure reduction achieved by ACE inhibitors, ARBs and renin inhibitors, and the 2 mmHg pulse pressure reduction with non-selective beta-blockers as shown in other Cochrane reviews, which compared these antihypertensive drug classes with placebo and used similar inclusion/exclusion criteria.Thiazides did not increase withdrawals due to adverse effects in these short-term trials but there is a high risk of bias for that outcome. Thiazides reduced potassium, increased uric acid and increased total cholesterol and triglycerides.

Chronic antihypertensive therapy with thiazide diuretics in older women and risk of osteoporotic vertebral fractures: A recently much-debated association

“…This topic has attracted the interest of epidemiologists and clinicians, also because the propitiation or aggravation of osteoporosis may substantially cancel or diminish the overall therapeutic advantage arising from the beneficial effect on the cardiovascular apparatus exerted by thiazide diuretics used for primary or secondary cardiovascular prevention ( 27).…”

Тіазиди Або Тіазидоподібні Діуретики В Лікуванні Артеріальної Гіпертензії?

“…По данным большинства исследований, в среднем по сравнению с плацебо эти препараты обеспечивают снижение систолического АД (САД) на 10-15 мм рт.ст., а диастолического АД (ДАД) -на 5-10 мм рт.ст. По данным метаанализа Cochrane, ГХТЗ имеет дозозависимый антигипертензивный эффект в отличие от других тиазидоподобных ди-уретиков [18]. При монотерапии дозы ГХТЗ 6,25; 12,5; 25 и 50 мг обеспечивают снижение САД/ДАД в среднем на 4/2, 6/3, 8/3 и 11/5 мм рт.ст., ХТД от 12,5 до 75 мг -12/4 мм рт.ст., индапамид от 1 до 5 мг -9/4 мм рт.ст.…”

“…рецепторов ангиотензина II и бета-адреноблокато-ры, снижают пульсовое АД [18]. По данным статистики США, приблизительно 30-40 % людей являются солечувствительными, т.е.…”

Should we switch from bendrofluazide to chlorthalidone as the initial treatment for hypertension? A review of the available medication

“…5 Thiazide-like diuretics have a longer elimination half-life than thiazide-type diuretics, and have been shown to exert additional pharmacological effects, which may differently affect cardiovascular risk. 4 Thiazide-type diuretics include bendrofluazide, chlorothiazide and hydrochlorothiazide.…”