Synapse
⌘+K
Synapse
PulseExploreClubsResearchersJournals
Instagram
HomeClubsExplore
September 1, 2001Journal of Clinical HypertensionOpen Access

Low‐Dose Combination Therapy: Why Include a Diuretic?

View Full Paper
Ask AI
Bookmark
Share

Why the study?

Does initial treatment with low-dose combination therapy including a diuretic improve blood pressure control in hypertensive patients compared to monotherapy?

Population

Hypertensive patients

Comparison

Low-dose fixed-dose combination antihypertensive… vs Antihypertensive monotherapy or combination…

Design

Editorial

Authors

EFEdward D. FreisGeneral / Preventive / Lipids

Discussion

Loading...

Member takes

Implication

Initiating hypertension treatment with a low-dose combination pill containing a diuretic improves blood pressure control and may enhance patient compliance compared to monotherapy.

Key Points

  • To evaluate the efficacy and clinical rationale for using low-dose, fixed-dose combination therapy containing a diuretic rather than stepped monotherapy for hypertension.
  • Review of randomized, double-blind trials evaluating antihypertensive monotherapies and fixed-dose combinations.
  • Included studies evaluated regimens such as captopril plus hydrochlorothiazide (N=475), diltiazem plus enalapril (N=891), bisoprolol plus hydrochlorothiazide (N=218), and sequential dual therapies (N=102).
  • Adding hydrochlorothiazide to captopril reduced blood pressure by an average of 24.4/16.2 mm Hg compared to 12.2/9.4 mm Hg with captopril monotherapy alone.
  • Bisoprolol combined with hydrochlorothiazide achieved goal diastolic blood pressure in 71% of patients with a 13.4/10.7 mm Hg reduction, compared to 69% (12.8/10.2 mm Hg) with amlodipine and 45% (7.3/6.6 mm Hg) with enalapril.
  • In patients unresponsive to single drugs, combinations containing hydrochlorothiazide achieved target systolic blood pressure in 77% and diastolic in 69%, compared to 46% and 51% for combinations lacking a diuretic.

Structured PICO

Does initial treatment with low-dose combination therapy including a diuretic improve blood pressure control in hypertensive patients compared to monotherapy?

P
Population
Hypertensive patients
I
Intervention
Low-dose fixed-dose combination antihypertensive therapy including a diuretic (e.g., hydrochlorothiazide)
C
Comparator
Antihypertensive monotherapy or combination therapy without a diuretic
O
Outcome
Blood pressure reduction to goal levels (e.g., <140/90 mm Hg)surrogate

Initiating hypertension treatment with a low-dose combination pill containing a diuretic improves blood pressure control and may enhance patient compliance compared to monotherapy.

Limitations

  • Small sample sizes in some cited trials

Cite This Study

Edward D. Freis (2001) studied this question.

synapsesocial.com/papers/6a7336489ac491c14dc3fa6ahttps://doi.org/10.1111/j.1524-6175.2001.01210.x

Topics

Hypertension management
View Full Paper
Ask AI
Bookmark
Share

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Response to a second single antihypertensive agent used as monotherapy for hypertension after failure of the initial drug. Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents1995 · 56 citations
  2. 2Single-Drug Therapy for Hypertension in Men -- A Comparison of Six Antihypertensive Agents with Placebo1993 · 1,202 citations
  3. 3Captopril: Evaluation of Low Doses, Twice-Daily Doses and the Addition of Diuretic for the Treatment of Mild to Moderate Hypertension1982 · 70 citations
  4. 4The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure1997 · 5,666 citations
  5. 5Diuretics Revisited—Again2001 · 7 citations