On the other hand it has been known, for many years, that when an ACE-inhibitor is added to a thiazide, the metabolic effects of the diuretic are minimized.In the ACCOMPLISH trial (19) (Avoiding CV events through combination therapy in patients living with systolic hypertension) 11,506 patients with hypertension who were at high risk for CV events, were randomised to receive treatment with either benazepril plus amlodipine or benazepril plus HCTZ. 1. Although diuretic use declined for 20 years, 1 it has begun to increase.
He concludes that the 2 studies are not comparable, and that the choice of appropriate therapy should me made according to the specific problems of the patient.Recent epidemic of obesity and diabetes raised again the problem of adverse effect of thiazides, namely the metabolic effects. To get the best experience using our website we recommend that you upgrade to a newer version. Prescription diuretic medications are grouped into three main types.
Did you know that your browser is out of date? The onset of action occurs after 2 to 3 hours for most thiazides. Thus treatment withdrawal could potentially separate the drug induced NOD from spontaneously occurring NOD (15).The difficulty in establishing a clinical connection between diuretic treatment and NOD is the absence of a link between diuretics and hyperglycemia. Chlorthalidone has an elimination half-life of 50 t0 60 hours, and is twice as potent as hydrochlorothiazide. Thiazyde-Type Diuretics and Beta-adrenergic Blockers as © 2020 European Society of Cardiology. The main benefits of antihypertensive therapy are due to lowering of blood pressure, per se, regardless of how it is obtained. 7–9 Meta-analysis 10 of 19 trials found 24-hour BP was higher with 12.5- to 25-mg doses of HCTZ compared with other antihypertensive drugs (systolic BP 4.5 to 6.2 mm Hg higher, diastolic BP 2.9 to 6.7 mm Hg higher).. The authors concluded that Ace-inhibitor+CCB was superior to ACE-inhibitor+HCTZ in reducing CV events in patients with hypertension who were at high risk for such events. Evidence from randomized clinical trials needs to be considered in decisions about agent choice and dose. How this is achieved is less important. The characteristics of the two populations were different with 35% of blacks in ALLHAT and only 5% in ANBP2. There were 552 primary-outcome events in the benazepril-amlodipine group (9.6%) and 679 in the benazepril-HCTZ group (11.8 %), representing a relative risk reduction of 19.6% (P<0.001). Thiazide diuretics, like hydrochlorothiazide and chlorthalidone, are extremely popular medications, often regarded as first-line agents in treatment … The experimental evidence that ACE-inhibitors and CCB have vasoprotective effects may be important, as well. Most Thiazides have a half-life of 8 to 12 hours, just permiting effective once daily dosing 3. More recently the results of renal outcome have showed that benazepril +amlodipine slows the progression of nephropathy to a greater extent (20). We have presented major trials on this subject in this review.Thiazide Diuretics have been used since the late fifties in the treatment of hypertension and remain one of the most important group of drugs used to reduce blood pressure, due to their efficacy and cost-effectiveness profile.The onset of action occurs after 2 to 3 hours for most thiazides, with little natriuretic effect occuring beyond 6 hours (2).
Cutler JA, Davis BR. All rights reserved. Context. Zillich et al (17) conducted a literature search from 1966 to 2004 to identify clinical trials using thiazides where the metabolic effect on potassium and glucose are reported. The use of diuretics (and beta-blockers) to treat hypertension has known a dramatic decline since the early 1980’s through to the early 1990s with the introduction of ACE-inhibitors and calcium channel blockers. We must rely on less rigorous study designs and other outcomes.Chlorthalidone reduces systolic blood pressure (BP) better than HCTZ at equivalent doses with similar effects on potassium levels-25 mg of chlorthalidone, compared with 50 mg of HCTZ, provided superior BP reduction overall (12 vs 7 mm Hg on 24-hour monitor) and at nighttime (13 vs 6 mm Hg).Retrospective (and thus not definitive) analysis of the MRFIT trial found that the chlorthalidone-based regimen reduced mortality compared with the HCTZ-based regimen (hazard ratio 0.79, 95% CI 0.68 to 0.92, -the “other thiazides” were not just HCTZ, as many reviewers assumed: 2 were HCTZ combined with potassium-sparing diuretics; 1 was indapamide (not HCTZ).Thiazide diuretics are first-line for hypertensive patients without compelling indications for alternate drugs.Chlorthalidone has a longer half-life than HCTZ (50 to 60 vs 9 to 10 hours), which might explain the superior BP control, especially at nighttime.The advantage of HCTZ is its availability in many combination preparations, which can improve adherence.Indapamide is another thiazide-like diuretic with good evidence for reduction in cardiovascular end points as first- or second-line antihypertensive therapy.Prescribe 12.5 mg of chlorthalidone daily; this can be increased to 25 mg daily (quarter and half a 50-mg tablet, respectively). No trials compare HCTZ with other thiazide diuretics in terms of cardiovascular or mortality outcomes.
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