Key result
Hydrochlorothiazide 25 mg was similarly effective to 50 mg in controlling blood pressure (78% vs 89%) in elderly patients with isolated systolic hypertension, but caused less serum potassium reduction.
Why the study?
Does 25 mg of hydrochlorothiazide compared to 50 mg provide similar blood pressure reduction with better safety in elderly patients with isolated systolic hypertension?
RCT (n=51)
Double-blind
randomized
Does 25 mg of hydrochlorothiazide compared to 50 mg provide similar blood pressure reduction with better safety in elderly patients with isolated systolic hypertension?
Absolute Event Rate: 78% vs 89%
Hydrochlorothiazide 25 mg is effective and well tolerated for isolated systolic hypertension in the elderly, offering similar blood pressure control to 50 mg with less potassium depletion.
Supports 25 mg hydrochlorothiazide as preferred initial dose for elderly isolated systolic hypertension; confirms similar efficacy with better potassium safety in this RCT.
In a double-blind randomized study, we evaluated the effects of 25 mg vs 50 mg of hydrochlorothiazide in 51 elderly patients (aged 68.9+-7.0 years) with isolated systolic hypertension (blood pressure, 160 to 239 mm Hg systolic and <90 mm Hg diastolic). Dose levels could be increased to twice daily to control blood pressure. The reductions in blood pressure (25.4/6.8 mm Hg and 28.9/7.4 mm Hg) and proportion of patients in whom blood pressure was controlled (78% and 89%) were similar in the lower- and higher-dose groups during the titration phase. However, serum potassium level was reduced more in the higherdosage (0.57 mmol/L) than the lower-dosage (0.17 mmol/L) group. There were no significant changes in blood pressure during a 24-week maintenance phase. No patient required withdrawal from the study because of adverse effects, and cognitive-behavioral function was well preserved. We conclude that hydrochlorothiazide is effective and well tolerated in older patients with isolated systolic hypertension, many of whom may be effectively treated with 25 mg of hydrochlorothiazide once daily. (Arch Intern Med. 1991;151:1954-1960)
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William C. Cushman (1991) conducted an RCT in isolated systolic hypertension (n=51). hydrochlorothiazide vs. 50 mg hydrochlorothiazide was evaluated on Proportion of patients in whom blood pressure was controlled. Hydrochlorothiazide 25 mg was similarly effective to 50 mg in controlling blood pressure (78% vs 89%) in elderly patients with isolated systolic hypertension, but caused less serum potassium reduction.
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