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Should Thiazide Diuretics be Given as First Line Antihypertensive Therapy or in Addition to Other Medications?

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Abstract

Introduction

The recommendation to start antihypertensive therapy with diuretics (D) might produce delay in blood pressure (BP) control and, possibly, increase cost/benefit ratio.

Aim

We evaluate the effects of D in relation to the administration of other anti-hypertensive medications, in clinical practice.

Methods

General practitioners recruited 2,409 hypertensive patients with indication to antihypertensive therapy, who were randomized to start treatment with chlorthalidone (12.5–25  mg daily, group D) or any other single medications (excluding thiazides, group A). The patients have been followed for at least 2 years.

Result

Among the 2,409 patients recruited (42.5 % women), 1,205 were randomized in group D and 1,204 in group A, of which 1,051 (or 87 %) and 1026 (or 85 %) respectively, completed the study. The number of patients in optimal BP control was similar in the two groups (65.0 vs 64.0 %; p = NS). During follow-up, the group D had prescribed a slightly greater number of medications compared to the group A who added D as second line (2.3 vs 2.1; p < 0.0001). In particular group D took more β-blockers (27.1 vs 14.9 %; p < 0.0001) with a similar number of patients in optimal BP control (64.35 vs 63.9 %; p = NS).

Conclusion

The beginning of antihypertensive therapy with diuretics is more often subject to the addition of one or more medications to obtain an effective blood pressure control, since the diuretic administered at the beginning of the antihypertensive regimen is only rarely associated with optimal blood pressure control.

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Authors and Affiliations

  1. Hypertension Research Center, Federico II University Hospital, via S. Pansini 5, bld. 2, 80131, Naples, Italy

    Valentina Trimarco, Raffaele Izzo, Teresa Migliore, Marina Marino, Maria Virginia Manzi, Marina De Marco, Giovanni de Simone & Nicola De Luca

  2. Department of Neurosciences, Federico II University, Naples, Italy

    Valentina Trimarco

  3. Department of Translational Medical Sciences, Federico II University, Naples, Italy

    Raffaele Izzo, Teresa Migliore, Marina Marino, Maria Virginia Manzi, Marina De Marco, Giovanni de Simone & Nicola De Luca

  4. School of Medicine, University of Salerno, Fisciano, Italy

    Francesco Rozza

Authors
  1. Valentina Trimarco
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  2. Raffaele Izzo
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  3. Teresa Migliore
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  4. Francesco Rozza
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  5. Marina Marino
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  6. Maria Virginia Manzi
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  7. Marina De Marco
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  8. Giovanni de Simone
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  9. Nicola De Luca
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Corresponding author

Correspondence to Nicola De Luca.

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Trimarco, V., Izzo, R., Migliore, T. et al. Should Thiazide Diuretics be Given as First Line Antihypertensive Therapy or in Addition to Other Medications?. High Blood Press Cardiovasc Prev 22, 55–59 (2015). https://doi.org/10.1007/s40292-014-0065-0

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  • DOI: https://doi.org/10.1007/s40292-014-0065-0

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