Key result
The addition of hydrochlorothiazide to verapamil resulted in no added blood pressure lowering benefit (150/95 mm Hg vs 150/95 mm Hg) in patients with mild to moderate essential hypertension.
Why the study?
Does the addition of hydrochlorothiazide to verapamil improve blood pressure reduction in patients with mild to moderate essential hypertension?
Does the addition of hydrochlorothiazide to verapamil improve blood pressure reduction in patients with mild to moderate essential hypertension?
The addition of hydrochlorothiazide to verapamil does not provide additional blood pressure lowering benefit in mild to moderate essential hypertension and may worsen hypokalemia.
May not enhance BP control with verapamil; Level 5 evidence leaves open diuretic combinations in other hypertensive populations.
Calcium channel blockers, a newer class of antihypertensive medications, have gained considerable acceptance as monotherapeutic agents, particularly in low renin hypertension where diuretics are also most effective. To study whether thiazide diuretics exert an additional antihypertensive effect in the setting of calcium channel blockade, we gave verapamil hydrochloride (360 mg/d) or hydrochlorothiazide (25 mg/d) alone and in combination in an open study to 13 hypertensive patients with mild to moderate essential hypertension. Both verapamil and hydrochlorothiazide lowered blood pressure (170 +/- 17/109 +/- 6 mm Hg pretreatment to 150 +/- 25/95 +/- 8 mm Hg with verapamil; 170 +/- 5/109 +/- 2 mm Hg pretreatment to 164 +/- 25/103 +/- 10 mm Hg with hydrochlorothiazide), but addition of hydrochlorothiazide to verapamil resulted in no added benefit (150 +/- 25/95 +/- 8 mm Hg vs 150 +/- 20/95 +/- 6 mm Hg). Furthermore, while hydrochlorothiazide lowered serum potassium values (4.2 +/- 0.25 mmol/L to 3.7 +/- 0.35 mmol/L) and stimulated plasma renin activity (1.5 +/- 1.3 ng/mL/h) pretreatment to 3.3 +/- 2.7 ng/mL/h with verapamil), verapamil only modestly elevated renin activity (1.5 +/- 1.3 ng/mL/h pretreatment to 2.7 +/- 2.5 ng/mL/h with verapamil) and did not lower potassium values. Altogether, the data suggest that in essential hypertension, at least for verapamil, concurrent diuretic therapy may not be helpful or warranted.
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John Nicholson (1989) studied Mild to moderate essential hypertension (n=13). Hydrochlorothiazide added to verapamil vs. Verapamil alone was evaluated on Blood pressure. The addition of hydrochlorothiazide to verapamil resulted in no added blood pressure lowering benefit (150/95 mm Hg vs 150/95 mm Hg) in patients with mild to moderate essential hypertension.
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