Eugene Yang, MD, FACC
What is the efficacy of hydrochlorothiazide (HCTZ) for reducing ambulatory blood pressure (BP) in patients with hypertension?
Included studies compared HCTZ monotherapy with other antihypertensive drugs in patients with hypertension, had duration ≥ 4 weeks, and reported 24-hour ambulatory BP. Outcomes were reduction in systolic BP (SBP) and diastolic BP (DBP).
MEDLINE, EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Trials (Cochrane Library, 2009, Issue 2), and reference lists were searched for randomized controlled trials (RCTs) fully published in peer-reviewed journals between 1966 and Mar 2010. 19 RCTs (n = 1463, mean age 58 y, 54% men) met the selection criteria: 14 (n = 1234) used low-dose HCTZ, 12.5 to 25 mg/d, and 5 (n = 229) used higher-dose HCTZ, up to 50 mg/d. HCTZ was compared with atenolol or losartan in 4 trials each; amlodipine in 3 trials; enalapril, isradipine, and lisinopril in 2 trials each; and 1 trial each evaluated nifedipine, telmisartan, spirapril, bisoprolol, irbesartan, quinapril, ramipril, candesartan, pinacidil, indapamide, zofenopril, felodipine, perindopril, and lacidipine. Follow-up varied from 4 to 95 weeks (median 8 wk).
In the 14 trials of HCTZ, 12.5 to 25 mg/d, mean baseline BP was 148/92 mm Hg. Meta-analysis showed that angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs), β-blockers, and calcium antagonists were each better than HCTZ, 12.5 to 25 mg/d, for reducing 24-hour ambulatory SBP and DBP (Table).
Low-dose hydrochlorothiazide is not as effective as other antihypertensive drugs for reducing ambulatory blood pressure in patients with hypertension.
Hydrochlorothiazide, 12.5 to 25 mg/d, vs other antihypertensive drugs in patients with hypertension*
*ACE-I = angiotensin-converting enzyme inhibitors; ARB = angiotensin-receptor blockers; BP = blood pressure; other abbreviations defined in Glossary.
†Mean difference > 0 indicates greater reduction with other antihypertensive drugs. Random-effects analyses were used unless indicated otherwise.
§Corrected data provided by author.
Eugene Yang. Review: Low-dose hydrochlorothiazide is not as effective as other antihypertensive drugs for reducing ambulatory BP in hypertension?. Ann Intern Med. 2011;154:JC5–8. doi: 10.7326/0003-4819-154-10-201105170-02008
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Published: Ann Intern Med. 2011;154(10):JC5-8.
Cardiology, Coronary Risk Factors, Hypertension, Nephrology.
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