Antihypertensive effect of low-dose hydrochlorothiazide alone or in combination with quinapril in black patients with mild to moderate hypertension. Antihypertensive effects of amlodipine and hydrochlorothiazide in elderly patients with ambulatory hypertension. Low dose hydrochlorothiazide (12.5 to 25 mg daily) as monotherapy in black patients with mild to moderate hypertension. Assessment by ambulatory blood pressure monitoring. Antihypertensive effects of two fixed-dose combinations of losartan and hydrochlorothiazide versus hydrochlorothiazide monotherapy in subjects with ambulatory systolic hypertension. Antihypertensive Effects of Valsartan/Hydrochlorothiazide Combination in Essential Hypertension Efficacy of Low-Dose Hydrochlorothiazide in Combination with Telmisartan on Early Morning Blood Pressure in Uncontrolled Hypertensive Patients Pharmaceutical care program for patients with uncontrolled hypertension. Report of a double-blind clinical trial with ambulatory blood pressure monitoring. Candesartan plus hydrochlorothiazide fixed combination vs previous monotherapy plus diuretic in poorly controlled essential hypertensive patients Monotherapy with amlodipine or hydrochlorothiazide in patients with mild to moderate hypertension: Comparison of their efficacy and effects on electrolytes Aliskiren-based stepped-care treatment algorithm provides effective blood pressure control. Efficacy and safety of fosinopril/hydrochlorothiazide combinations on ambulatory blood pressure profiles in hypertension. Fosinopril/Hydrochlorothiazide Investigators. Double-blind, parallel, comparative multicentre study of a new combination of diltiazem and hydrochlorothiazide with individual components in patients with mild or moderate hypertension. Comparative Antihypertensive Effects of Hydrochlorothiazide and Chlorthalidone on Ambulatory and Office Blood Pressure A randomized, controlled trial comparing diltiazem, hydrochlorothiazide, and their combination in the therapy of essential hypertension. A dose escalation trial comparing the combination of diltiazem SR and hydrochlorothiazide with the monotherapies in patients with essential hypertension. A home blood pressure monitoring study comparing the antihypertensive efficacy of two angiotensin II receptor antagonist fixed combinations. Increased efficacy and tolerability with losartan plus hydrochlorothiazide in patients with uncontrolled hypertension and therapy-related symptoms receiving two monotherapies.
In this study , using 24-hour ambulatory blood pressure ( BP ) monitoring , the authors assessed the potential for BP control using hydrochlorothiazide ( HCTZ , 12.5 mg daily ) , given as a monotherapy over 12 months to 49 black South African patients with mild to moderate hypertension ( mean day diastolic blood pressure [ DBP ] > or = 90 and < 115 mmHg ) . Uncontrolled patients received fixed combination of quinapril/HCTZ 10/12.5 , 20/12.5 , and 20/25 mg , with dose titration at 3 monthly intervals if BP control was not achieved ( day DBP < 90 mmHg ) . Overall , profound and sustained BP reduction was observed at the end of the study . The 24-hour BP decreased from 151 + /- 14/98 + /- 7 to 136 + /- 15/87 + /- 9 mmHg ( p < 0.0001 at end of study vs. baseline ) ; the mean day BP decreased from 155 + /- 14/104 + /- 7 to 140 + /- 15/91 + /- 10 mmHg ( p < 0.0001 at end of study vs. baseline ) . The overall control ( mean day DBP < 90 mmHg ) and response ( decrease in day DBP > or = 10 mmHg ) rates were 49 % and 61 % , respectively . At the end of the study , only 2 patients ( 4 % ) remained on treatment with HCTZ . Out of the initial 12 patients controlled on HCTZ at 3 months ( 12/49 , 24 % ) , 5 patients remained controlled at 6 months and only 1 patient at 12 months . In contrast , quinapril/HCTZ combinations maintained their antihypertensive effect up to 9 months , with a significant number of patients ( 22/49 , 45 % ) requiring the highest dose of the combination ( 20/25 mg daily ) . In conclusion , low-dose HCTZ should not be recommended as monotherapy in black patients with mild to moderate hypertension due to the fact that the BP-lowering effect is attenuated already at 6 months of treatment , with most patients requiring the addition of the ACE inhibitor Recent studies and authorities have advocated the use of low-dose thiazide diuretics as first-line treatment agents in elderly hypertensives . However , these recommendations were based solely on blood pressure ( BP ) measured in the clinic . The objective of the present 32-week double-blind study was to compare the effects of hydrochlorothiazide ( HCTZ ) and amlodipine ( AML ) in elderly patients with confirmed ambulatory hypertension . After a 4-week placebo washout period , 42 ( 25 men , 17 women ) patients ( mean age , 69 years ) with clinic sitting diastolic BP of 95 to 114 mm Hg and daytime ambulatory diastolic BP of > or = 90 mm Hg were r and omized double-blind to receive AML 5 to 10 mg ( n = 21 ) or HCTZ 12.5 to 25 mg ( n = 21 ) once daily . After 8 weeks of monotherapy , patients in whom clinic diastolic BP remained > or = 90 mm Hg were given combination therapy with the other agent . Amlodipine monotherapy induced significant reductions in clinic , mean 24-h , daytime and sleep systolic/diastolic BPs whereas only clinic BP decreased significantly in patients treated with HCTZ monotherapy . Moreover , 19/21 versus 8/21 patients on AML and HCTZ monotherapies achieved adequate BP control . At the end of the 32-week treatment period , combination therapy in the HCTZ group result ed in statistically significant reductions in clinic as well as in 24-h , daytime and sleep ambulatory BPs that were similar to those observed in the AML monotherapy group . In conclusion , the administration of AML monotherapy induced significant reductions in both clinic and ambulatory BPs in elderly patients whereas only clinic BP was significantly decreased by HCTZ monotherapy . Moreover , the addition of AML to HCTZ in patients inadequately controlled by monotherapy has permitted statistically significant decrements in clinic as well as in ambulatory BP . Consequently , the results of the present study suggest that the use of HCTZ in doses of up to 25 mg daily is inadequate for ambulatory BP control in the elderly despite official recommendations The efficacy of low dose ( 12.5 to 25 mg daily ) hydrochlorothiazide ( HCTZ ) was evaluated by ambulatory blood pressure monitoring ( ABPM ) in 19 mild to moderate hypertensive ( mean daytime 12-h diastolic BP > or = 90 mm Hg and < 115 mm Hg ) South African black patients . After a 3-week placebo run-in period , HCTZ was administered for 8 weeks as monotherapy . The mean daytime ABPM was reduced from 159 + /- 13/105 + /- 6 to 145 + /- 11/97 + /- 10 mm Hg ( P < .005 ) . Only 6/19 ( 32 % ) patients achieved BP control . The 24-h BP load fell from 69 % at baseline , to 53 % with 12.5 mg HCTZ and to 47 % with 25 mg HCTZ daily . There were no side effects but the increase of HCTZ to 25 mg daily was followed by adverse changes ( P < .05 ) in serum potassium levels . It is concluded that low dose of HCTZ monotherapy has only a moderate effect on the BP control and 24-h BP load while the higher 25 mg dose is associated with significant decrease in serum potassium level BACKGROUND The efficacy of losartan ( L ) in combination with hydrochlorothiazide ( HCTZ ) has been demonstrated to reduce blood pressure . However , there are limited data on the effects of L/HCTZ combinations versus HCTZ monotherapies in reducing ambulatory systolic blood pressure . The aim of this study was to compare the effects of these treatment approaches in patients with ambulatory systolic hypertension . METHODS Patients were r and omized to receive L 50 mg ( n = 60 ) or HCTZ 12.5 mg ( n = 60 ) for 6 weeks . Patients were then force-titrated to L 50/HCTZ 12.5 mg and to L 100/HCTZ 25 mg or were sham-titrated to HCTZ 12.5 mg and force-titrated to HCTZ 25 mg , respectively . Clinic and 24-h ambulatory blood pressure ( ABP ) were measured at baseline and after each 6-week treatment period . RESULTS We found that L 50 and HCTZ 12.5 induced significant and similar decreases in clinic and ABP . The combinations of L 50/HCTZ 12.5 and L 100/HCTZ 25 provided significantly greater decreases in clinic and ABP than did HCTZ monotherapies . The L 50/HCTZ 12.5 and L 100/HCTZ 25 combinations provided significant additional decreases in systolic/diastolic ABP during daytime ( -5.3/-2.0 mm Hg ; P < .001 and -5.8/-3.4 mm Hg ; P < .001 ) and the other periods of the 24-h interval compared with the levels achieved by the previous treatment , indicating a clear dose-response relationship . However , increasing the dose of HCTZ from 12.5 mg to 25 mg was not associated with additional ABP reductions . CONCLUSIONS Combinations of L 50/HCTZ 12.5 and L 100/HCTZ 25 provided greater reductions in clinic and ABP than HCTZ monotherapies , with a clear dose-response relationship with regard to ABP . These results support the use of ABP monitoring when assessing the efficacy of antihypertensive therapies Fixed-dose combination therapy has received increased interest since publication of JNC-VI report and WHO/ISH guidelines 1999 . We compared in a r and omized , double-blind study the efficacy and tolerability of valsartan 80 mg combined with hydrochlorothiazide ( HCTZ ) 12.5 mg to monotherapy with either HCTZ 12.5 mg or 25 mg in patients with essential hypertension inadequately controlled by previous HCTZ 12.5 mg monotherapy . Two hundred and seventeen patients whose blood pressure ( BP ) control remained poor ( 95 mmHg h sitting diastolic BP < 115 mmHg ) after a 4-week single-blind period with HCTZ 12.5 mg were r and omized to receive either combination therapy with valsartan 80 mg plus HCTZ 12.5 mg ( V/HCTZ ) or monotherapy with HCTZ 12.5 mg or HCTZ 25 mg for 8 weeks . Reduction of sitting trough diastolic BP between baseline and week 8 as well as tolerability was evaluated . Reduction in trough diastolic BP was most pronounced in the V/HCTZ group ( –11.3 mmHg ) and significantly greater than in the HCTZ 12.5 mg group ( –2.9 mmHg , p < 0.001 ) and the HCTZ 25 mg group ( –5.7 mmHg , p < 0.001 ) . Tolerability of study medication was comparable between all three groups . In conclusion , switching to V/HCTZ combination therapy provides an additional lowering of BP compared to dosage increase of the thiazide in patients with BP insufficiently controlled by HCTZ 12.5 mg monotherapy Hypertensive patients whose BP was uncontrolled despite the use of antihypertensive agents , including an ARB ( c and esartan 8 mg/day or valsartan 80 mg/day ) , were enrolled . The patients were r and omly assigned to combination therapy with telmisartan 40 mg/day ( changed from current ARB ) and hydrochlorothiazide ( HCTZ ) 12.5 mg/day ( T + H , n = 32 ) or to no change in their current drug regimen ( CTL , n = 32 ) . The observation period was 12 weeks . The office and home BPs were significantly reduced in the T + H compared to those in the CTL . A sufficient and long-acting BP lowering effect , as reflected in decreased early morning BP , was obtained with the combination of low-dose HCTZ and telmisartan without apparent metabolic deterioration BACKGROUND Pharmaceutical care programs may be an option to improve blood pressure ( BP ) control in patients with uncontrolled hypertension . The aim of this study was to evaluate the efficacy of pharmaceutical care programs in treating patients with resistant hypertension . METHODS In a double-blind r and omized clinical trial , 71 patients with uncontrolled BP were enrolled in a pharmaceutical care program or in a control group and underwent a series of cognitive tests . The primary outcome was change in ambulatory BP ( ABP ) between the baseline evaluation and the final visit 6 months later . The secondary outcomes were the frequency of drug-related problems and adherence as determined by plasma levels of hydrochlorothiazide . RESULTS The delta-values between the intervention and control groups for ABP in the different daily periods , with the corresponding 95 % confidence limits , adjusted for age and baseline BP were : 3 ( -1 to 5 ) , 2 ( -2 to 4 ) , and 5 ( -1 to 6 ) mm Hg for 24 h , daily and nightly systolic BP , respectively . The corresponding values for diastolic BP were 1 ( -1 to 3 ) , 0 ( -2 to 2 ) , and 3 ( -1 to 4 ) mm Hg , respectively .  Hydrochlorothiazide  was detected in the plasma in 21 of 27 patients in the intervention group that attended to all appointments and 24 of 30 patients in the control group ( P = .904 ) . CONCLUSIONS The pharmaceutical care program tested in this trial was feasible and showed a trend for better BP control in patients with uncontrolled hypertension Objective : To assess efficacy and tolerability of c and esartan cilexetil ( CC ) plus hydrochlorothiazide ( HCTZ ) fixed combination vs previous monotherapy ( PM ) plus HCTZ in hypertension . Design and Methods : After 2 - 4 weeks of run in , 409 out patients ( diastolic blood pressure , DBP > 90 and ≤⃒110 mmHg ; systolic blood pressure , SBP ≤⃒180 mmHg ) , aged 26 - 79 years , under monotherapy , were r and omized in a PROBE multicenter trial to CC 16 mg plus HCTZ 12.5 mg or PM plus HCTZ 12.5 mg for 8 weeks . HCTZ was doubled after the first 4 weeks in non-responders ( DBP ≥90 mmHg or SBP > 180 mmHg ) . Results : Automatic oscillometric ( Omron 705 CP ) DBP and SBP were similarly reduced by CC + HCTZ and PM + HCTZ after 4 ( 12/15 and 10/13 mmHg ) and 8 weeks ( 13/20 and 12/18 mmHg ) in the intention-to-treat ( ITT , n = 398 ) population . HCTZ dose was doubled in 18.1 and 31.2 % of patients in the CC + HCTZ and PM + HCTZ group , respectively ( p < 0.05 ) . Rate of normalized patients ( DBP < 90 and /or SBP < 140 mmHg ) after 8 weeks of treatment was greater ( p < 0.05 ) under CC + HCTZ ( 82.0 vs 72.6 % vs PM + HCTZ ) . Pulse pressure was comparably reduced by CC + HCTZ and PM + HCTZ , at 4 ( 3 mmHg for both ) and 8 weeks ( 7 and 6 mmHg , respectively ) . Heart rate was unchanged . Results of per- protocol analysis ( n = 316 ) did not differ from those of ITT analysis . Rate of adverse events was low and comparable between groups . Conclusions : CC plus HCTZ fixed combination is an effective and safe alternative to other antihypertensive drugs , given either as monotherapy or in combination when they do not satisfactorily control patient 's blood pressure Background Amlodipine and hydrochlorothiazide ( HCTZ ) are commonly prescribed in Nigeria either as a monotherapy or in combination with other drugs . The present study was design ed to investigate the antihypertensive efficacy of monotherapy with amlodipine or HCTZ and their effects on electrolyte profile in patients with mild to moderate hypertension . Methods A single-blind r and omized clinical study was used ; fifty patients newly diagnosed with mild to moderate hypertension ( aged 33 to 60 years ) were recruited and divided into two groups : amlodipine or hydrochlorothiazide each comprising of 25 subjects . The subjects received 5 mg of amlodipine or 25 mg of hydrochlorothiazide in their respective group once daily for 4 weeks . Blood pressure , serum and urine electrolytes were measured at baseline and weekly throughout the experiment . Results At the end of follow up , amlodipine reduced systolic and diastolic blood pressure significantly more ( p<0.001 ) than HCTZ . At the end of follow up , blood pressure was reduced to normal in 80 % of the subjects in amlodipine group compared to 50 % in HCTZ . Amlodipine had no significant effect on electrolyte profile of subjects unlike HCTZ which significantly changed both their serum and urine electrolytes . Conclusions Monotherapy with amlodipine was more effective than HCTZ in black patients with mild to moderate hypertension and in addition maintained electrolyte balance AIMS Recent guidelines for the management of hypertension recommend an individualised stepped-care treatment approach in mild-to-moderate hypertensive patients , to achieve blood pressure ( BP ) goals . This study evaluated the probability of patients achieving BP targets  with an  aliskiren-based stepped-care treatment regimen . METHODS This was a 24-week , open-label , non-comparator study design that included six sequential 4-week treatment periods in patients with mild-to-moderate hypertension . Over the potential 24 weeks of active treatment , incremental therapy included the following add-on therapies at 4-week intervals : aliskiren 150 - 300 mg once daily , hydrochlorothiazide ( HCTZ ) 12.5 - 25 mg once daily , and finally amlodipine 5 - 10 mg once daily , as needed to achieve target BP . Subjects achieving BP targets following any given 4 weeks of therapy were considered study completers , while subjects not achieving their clinical BP target entered into the next step of incremental therapy . The primary efficacy end-point was the estimated cumulative probability of patients achieving BP target . RESULTS Of 256 patients treated , 232 ( 90.6 % ) completed the study .  Baseline mean sitting BP was 155.7/91.7 mmHg . At study end-point , the estimated cumulative probability of reaching BP target was 86.12 % . The stepped-care treatment regimen was well tolerated at the maximal recommended doses of all the individual complimentary therapies . CONCLUSION An aliskiren-based stepped-care treatment regimen that subsequently included both HCTZ and amlodipine is effective in achieving BP goals in approximately 90 % of patients with mild-to-moderate hypertension Twenty-four-hour ambulatory blood pressure monitoring ( ABPM ) was used to assess the antihypertensive efficacy and safety of the angiotensin converting enzyme ( ACE ) inhibitor fosinopril ( Fos ) in combination with hydrochlorothiazide ( HCTZ ) in doses of 10/12.5 mg and 20/12.5 mg taken once daily versus placebo in patients with mild-to-moderate hypertension . In two method ologically identical studies , the antihypertensive effects were evaluated by 24-h ABPM and by seated office diastolic ( DBP ) and systolic ( SBP ) blood pressures . After a 4- or 5-week placebo washout , 79 patients received r and omized , double-blind treatment for 8 weeks with either the Fos/HCTZ 10/12.5-mg dose combination ( n = 41 ) or placebo ( n = 38 ) , and in the second study , 62 patients were treated with either the Fos/HCTZ 20/12.5-mg dose combination ( n = 30 ) or placebo ( n = 32 ) . Changes from baseline in mean 24-h systolic and diastolic ABPM were significantly different from placebo for both doses ( SBP/DBP with 10/12.5 mg , -18.2/ -10.1 mm Hg , P < or= .001 ; SBP/DBP with 20/12.5 mg , -22.9/ -11.2 mm Hg , P < or= .001 ) ; whereas ambulatory SBP and DBP in the placebo group were virtually unchanged . Although the antihypertensive effect of the higher Fos/HCTZ dose combination ( 20/12.5 mg ) appeared greater than the lower dose ( 10/12.5 mg ) , no attempt was made to make a comparison between the two doses over these two independent studies . This difference in blood pressure lowering was not reproduced by the office blood pressure readings . Both dose combinations of Fos/HCTZ produced significantly greater reductions in the office seated DBP than placebo at all time points tested with a maximum treatment effect ( drug effect - placebo effect ) of -7.3 mm Hg for the 10/12.5-mg dose and -8.2 mm Hg for the 20/12.5-mg dose after 8 weeks of therapy ( P < or= .01 ) . Based on the results obtained in these trials , both dose combinations of Fos/HCTZ taken once daily were safe and effective in the management of patients with mild-to-moderate hypertension . Twenty-four-hour ABPM detected what appears to be an enhanced blood pressure reduction with the higher Fos/HCTZ dose combination ( 20/12.5 mg ) at peak and trough , which was not reproduced by trough office blood pressure measurements , suggesting greater sensitivity of 24-h ABPM for evaluating antihypertensive effects OBJECTIVE To compare the antihypertensive efficacy and tolerability of a new combination preparation of diltiazem ( 150 mg ) and hydrochlorothiazide ( 12.5 mg ) with the individual constituents in patients with mild/moderate hypertension . DESIGN Multi-centre , double-blind , r and omised parallel group study . PATIENTS Seventy-one patients with essential hypertension were recruited to the study . TREATMENT Following completion of the placebo run-in period 63 patients fulfilled the prer and omisation criteria and entered the 10 week treatment period . Patients were r and omised to receive either the combination preparation ( D 150 mg/H 12.5 mg ) , diltiazem ( 150 mg ) or hydrochlorthiazide ( 12.5 mg ) . The dosage was increased in three patients who had not attained target blood pressure ( BP ) control after 6 weeks . OUTCOME MEASURES Response to treatment assessed by change from baseline in clinic and 24 h ambulatory BP . RESULTS The proportion of patients achieving target BP ( a reduction in resting supine diastolic blood pressure ( DBP ) to below 90 mm Hg or a reduction of 10 mm Hg from baseline ) was 80 % in the combination group , 55 % in the diltiazem group , and 38 % in the hydrochlorothiazide group . The respective figures for reduction in supine DBP from baseline were 13.5 mm Hg , 11.2 mm Hg and 5.9 mm Hg . A similar treatment order appeared throughout each of the efficacy variables . BP control throughout the 24 h dosing interval was demonstrated by ambulatory BP monitoring . Each treatment was well tolerated . CONCLUSION This study provides clear evidence of the efficacy of combination therapy with diltiazem and hydrochlorothiazide in the management of patients with hypertension Low-dose thiazide-type diuretics are recommended as initial therapy for most hypertensive patients .  Chlorthalidone has significantly reduced stroke and cardiovascular end points in several l and mark trials ; however , hydrochlorothiazide remains favored in practice . Most clinicians assume that the drugs are interchangeable , but their antihypertensive effects at lower doses have not been directly compared . We conducted a r and omized , single-blinded , 8-week active treatment , crossover study comparing chlorthalidone 12.5 mg/day ( force-titrated to 25 mg/day ) and hydrochlorothiazide 25 mg/day ( force-titrated to 50 mg/day ) in untreated hypertensive patients . The main outcome , 24-hour ambulatory blood pressure ( BP ) monitoring , was assessed at baseline and week 8 , along with st and ard office BP readings every 2 weeks . Thirty patients completed the first active treatment period , whereas 24 patients completed both . An order – drug – time interaction was observed with chlorthalidone ; therefore , data from only the first active treatment period was considered . Week 8 ambulatory BPs indicated a greater reduction from baseline in systolic BP  with chlorthalidone 25 mg/day compared with hydrochlorothiazide 50 mg/day ( 24-hour mean = −12.4±1.8 mm Hg versus −7.4±1.7 mm Hg ; P=0.054 ; nighttime mean = −13.5±1.9 mm Hg versus −6.4±1.8 mm Hg ; P=0.009 ) . Office systolic BP reduction was lower at week 2 for chlorthalidone 12.5 mg/day versus hydrochlorothiazide 25 mg/day ( −15.7±2.2 mm Hg versus −4.5±2.1 mm Hg ; P=0.001 ) ; however , by week 8 , reductions were statistically similar ( −17.1±3.7 versus −10.8±3.5 ; P=0.84 ) . Within recommended doses , chlorthalidone is more effective in lowering systolic BPs  than hydrochlorothiazide , as evidence d by 24-hour ambulatory BPs . These differences were not apparent with office BP measurements STUDY OBJECTIVES To compare the efficacy of combination therapy with sustained-release diltiazem and hydrochlorothiazide ( DTZ SR-HCTZ ) with that of monotherapy with DTZ SR , HCTZ , or placebo in the treatment of essential hypertension ; and to determine whether the addition of a diuretic to diltiazem at apparent optimum doses of each agent significantly enhances their antihypertensive effects . DESIGN Multicenter , r and omized , double-blind , placebo-controlled , parallel-group trial with a 6-week treatment phase . SETTING Private and university-based clinics . PATIENTS AND PARTICIPANTS Subjects of either sex , ranging in age from 18 - 70 years , with a diagnosis of stable essential hypertension made from two consecutive weekly mean supine diastolic blood pressure ( DBP ) readings of 95 mm Hg or above to 110 mm Hg or less that varied 7 mm Hg or less after 4 - 6 weeks in the baseline phase . Of the patients enrolled , 298 met the inclusion criteria . INTERVENTIONS Combination therapy with DTZ SR-HCTZ 120 mg-12.5 mg , or monotherapy with DTZ SR 120 mg or HCTZ 12.5 mg , or placebo was administered twice daily . MEASUREMENTS AND MAIN RESULTS Combination therapy with DTZ SR-HCTZ lowered both supine DBP and SBP significantly ( p < 0.005 ) more than either single agent . The combination also lowered DBP and SBP significantly more than either monotherapy . During a 12-hour in-clinic monitoring period spanning a dosing interval , both the combination and DTZ SR therapies maintained efficacy , whereas the antihypertensive effects of HCTZ dissipated after 8 hours . Treatment-related adverse events for the combination and HCTZ were similar but slightly greater than those for DTZ SR and placebo . CONCLUSIONS The addition of a diuretic to sustained-release diltiazem produced an enhanced antihypertensive effect compared with monotherapy with either individual agent A multicentre , r and omised , placebo-controlled parallel group study comparing various doses of the combination diltiazem SR ( DTZ SR)/hydrochlorothiazide ( HCTZ ) with the monotherapies was performed to delineate the optimal antihypertensive dosage of the two drug combinations . The study was carried out in 298 patients with mild to moderate essential hypertension ( stable supine diastolic blood pressure , DBP , greater than or equal to 95 and less than or equal to 110 mmHg ) . After a single-blind placebo lead-in period lasting 4 - 6 weeks to establish stable baseline BP , the patients were r and omised to receive either placebo ( n = 75 ) , HCTZ ( n = 76 ) , DTZ SR ( n = 72 ) , or the combination of DTZ SR/HCTZ ( n = 75 ) . There were three 4-week evaluation periods with forced escalation of therapy as follows : HCTZ ( 6.25 , 6.25 , 12.5 mg twice daily ) , DTZ SR ( 60 , 90 , 120 mg twice daily ) , and the combination of DTZ SR/HCTZ ( 60/6.25 , 90/6.25 , 120/12.5 mg twice daily ) . DTZ SR/HCTZ ( 120/12.5 mg ) produced statistically significantly greater reductions in supine DBP compared with each monotherapy and placebo . The lower doses of DTZ SR/HCTZ ( 60/6.25 mg and 90/6.25 mg ) produced statistically significantly greater supine DBP reductions compared with DTZ SR monotherapy and placebo , but not compared with HCTZ monotherapy . A comparison of reduction in supine DBP between evaluation periods demonstrated a dose-response relationship for the combination therapy in reducing BP over the dosage range studied . Adverse clinical and laboratory events were not significantly different between the therapies . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND The objective of this prospect i ve , r and omized , open-label , blinded-endpoint study was to compare the antihypertensive efficacy of valsartan 80 mg v irbesartan 150 mg when combined with hydrochlorothiazide ( HCTZ ) 12.5 mg . METHODS Untreated or uncontrolled hypertensive adults ( n = 800 ) were enrolled by primary care physicians . After a 5-week open-label lead-in phase in which all patients received 12.5 mg HCTZ once daily , subjects whose blood pressure ( BP ) remained uncontrolled were r and omized ( n = 464 ) to valsartan/HCTZ ( 80/12.5 mg ) or irbesartan/HCTZ ( 150/12.5 mg ) for 8 weeks .  Home BP monitoring ( HBPM ) was performed in the morning and in the evening for 5 days , at baseline , and after 8 weeks . Office BP measurements were obtained at baseline and after 8 weeks . RESULTS Irbesartan/HCTZ produced greater reductions in average systolic BP ( SBP ) and diastolic BP ( DBP ) measured by HBPM than valsartan/HCTZ ( SBP : -13.0 v -10.6 mm Hg , P = .0094 ; DBP : -9.5 v -7.4 mm Hg , P = .0007 ) . These differences were more pronounced in the morning ( trough ) than in the evening . Office BP measurements also showed greater reductions in trough seated SBP and DBP with irbesartan/HCTZ compared with valsartan/HCTZ . Normalization rates observed with HBPM ( SBP < 135 mm Hg and DBP < 85 mm Hg ) were significantly greater with irbesartan/HCTZ than with valsartan/HCTZ ( 50.2 v 33.2 % ; P = .0003 ) . The overall safety was similar in the two groups . CONCLUSIONS The superior BP-lowering potency of the fixed combination irbesartan/HCTZ ( 150/12.5 mg ) over valsartan/HCTZ ( 80/12.5 mg ) , evidence d independently from the investigators by HBPM , supports the use of this technique in trials with prospect i ve , r and omized , open-label , blinded-endpoint design The efficacy and tolerability of losartan 100 mg/hydrochlorothiazide ( HCTZ ) 25 mg and enalapril 10 mg/HCTZ 25 mg were compared in a double-blind , r and omized trial in hypertensive patients inadequately controlled and experiencing side effects on prior therapy . Patients with moderate or severe hypertension , currently treated with at least two single-agent drugs ( excluding angiotensin-converting enzyme inhibitors ) , with a sitting diastolic blood pressure ( DBP ) above 90 mm Hg , and at least one undesirable drug-related symptom were r and omized to once-daily treatment with one of the combinations for 12 weeks .  Losartan/HCTZ lowered sitting DBP from the prior therapy baseline by 13.7 mm Hg and sitting systolic blood pressure 19.3 mm Hg ; similar reductions occurred with enalapril/HCTZ .  Trough sitting DBP was reduced to normal levels ( < 90 mm Hg ) in 63 % of patients switched to the losartan combination and in 58 % of those treated with the enalapril combination . Each combination was associated with improved tolerability compared with prior therapy , although fewer patients reported each of 24 undesirable symptoms after 12 weeks of losartan/HCTZ . The improvement from prior therapy in the occurrence of cough was significantly greater with losartan/HCTZ ( P = .005 ) . Enalapril/HCTZ , but not losartan/HCTZ , increased serum uric acid levels at week 12 . In conclusion , the combination of losartan 100 mg/HCTZ 25 mg offers a beneficial therapeutic option for patients with a history of moderate to severe hypertension whose blood pressure is not adequately controlled or who exhibit side effects while on two or more single-agent antihypertensive drugs . In this population , the switch from prior antihypertensive therapies to once daily losartan 100 mg/HCTZ 25 mg improves blood pressure control and reduces side effects
The antihypertensive efficacy of HCTZ in its daily dose of 12.5 to 25 mg as measured in head-to-head studies by ambulatory BP measurement is consistently inferior to that of all other drug classes .
Because outcome data at this dose are lacking , HCTZ is an inappropriate first-line drug for the treatment of hypertension
OBJECTIVES The purpose of this study was to evaluate the antihypertensive efficacy of hydrochlorothiazide ( HCTZ ) by ambulatory blood pressure ( BP ) monitoring .
BACKGROUND HCTZ is the most commonly prescribed antihypertensive drug worldwide .
More than 97 % of all HCTZ prescriptions are for 12.5 to 25 mg per day .
The antihypertensive efficacy of HCTZ by ambulatory BP monitoring is less well defined .