Second-Line Diuretics in Hypertension Reviewed

Findings suggest adding diuretic results in further blood pressure reductions
By Rick Ansorge
HealthDay Reporter

WEDNESDAY, Oct. 14 (HealthDay News) -- The addition of diuretics as a second-line approach to another anti-hypertensive agent further lowers systolic and diastolic blood pressure, providing the same effect as when used as first-line monotherapy, according to a review published online Oct. 7 in the Cochrane Database of Systematic Reviews.

Jenny M.H. Chen, M.D., of the University of British Columbia in Vancouver, Canada, and colleagues reviewed 53 trials in which 15,129 hypertensive patients with a mean baseline blood pressure of 156/101 mm Hg were randomly assigned to receive either a second-line thiazide diuretic or placebo. In 49 studies (92 percent), hydrochlorothiazide was used. They also reviewed three trials in which patients were randomly assigned to receive either a second-line loop diuretic or placebo.

The researchers found that second-line thiazide therapy at the manufacturer's recommended starting dose and two times the manufacturer's recommended starting dose was associated with blood pressure reductions of 6/3 mm Hg and 8/4 mm Hg, respectively. These reductions were similar to those seen with thiazide monotherapy. In addition, researchers found a starting dose of loop diuretics was associated with a blood pressure reduction of about 6/3 mm Hg.

"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 blood pressure lowering effect of thiazides is additive. Loop diuretics appear to have a similar blood pressure lowering effect as thiazides at one times the recommended starting dose," the authors conclude.


Copyright © 2009 ScoutNews, LLC. All rights reserved.

Powered by

jQuery UI Accordion - Default functionality

For life-long learning and continuing professional development, come to Lippincott's NursingCenter.

Nursing Jobs Plus
Featured Jobs
Recommended CE Articles Recommended Nursing Articles Evidence Based Practice Skin Care Network NursingCenter Quick Links What’s Trending Events