Key result
Low-dose diuretic therapy increased the achievement of optimal blood pressure compared to placebo (25.6% vs 19.3%, P<0.05) in adults with prehypertension, though most remained prehypertensive.
Why the study?
Does low-dose diuretic therapy (chlorthalidone 12.5 mg and amiloride 2.5 mg) improve the achievement of optimal blood pressure in adults with prehypertension?
RCT (n=730)
double-blinded
parallel
Yes
Does low-dose diuretic therapy (chlorthalidone 12.5 mg and amiloride 2.5 mg) improve the achievement of optimal blood pressure in adults with prehypertension?
Low-dose diuretic therapy modestly increases the probability of achieving optimal blood pressure in prehypertensive adults, though the majority still remain prehypertensive or progress to hypertension.
Answers are grounded in this paper and cite their sources.
Low-dose diuretics modestly increase optimal BP achievement in prehypertension; extends early pharmacologic prevention evidence but most remain above target.
BACKGROUND: To determine the effectiveness of low-dose diuretic therapy to achieve an optimal level of blood pressure (BP) in adults with prehypertension. METHODS: The PREVER-prevention trial was a randomized, parallel, double-blinded, placebo-controlled trial, with 18 months of follow-up, conducted at 21 academic medical centers in Brazil. Of 1772 individuals evaluated for eligibility, 730 volunteers with prehypertension who were aged 30-70 years, and who did not reach optimal blood pressure after 3 months of lifestyle intervention, were randomized to a fixed association of chlorthalidone 12.5 mg and amiloride 2.5 mg or placebo once a day. The main outcomes were the percentage of participants who achieved an optimal level of BP. RESULTS: A total of 372 participants were randomly allocated to diuretics and 358 to placebo. After 18 months of treatment, optimal BP was noted in 25.6% of the diuretic group and 19.3% in the placebo group (P < 0.05). The mean net reduction in SBP and DBP for the diuretic group compared with placebo was 2.8 mmHg (95% CI 1.1 to 4.5) and 1.1 mmHg (95% CI -0.09 to 2.4), respectively. Most participants in the active treatment group (74.5%) and in the placebo group (80.7%) continued to have BP in the prehypertension range or progressed to hypertension. CONCLUSION: Low-dose diuretic therapy increased the probability of individuals with prehypertension to achieve optimal BP but most of those treated continued to have a BP in the prehypertension range or progressed to having overt hypertension.
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Fuchs et al. (2017) conducted an RCT in prehypertension (n=730). chlorthalidone and amiloride vs. placebo was evaluated on percentage of participants who achieved an optimal level of BP (p=<0.05). Low-dose diuretic therapy increased the achievement of optimal blood pressure compared to placebo (25.6% vs 19.3%, P<0.05) in adults with prehypertension, though most remained prehypertensive.
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