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Morley-Senkler V, Jobin P, Wright JM. Blood pressure lowering effect of hydrochlorothiazide compared to other diuretics for hypertension. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2022; 2022:CD015250. [PMCID: PMC9678436 DOI: 10.1002/14651858.cd015250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: This review aims to assess the short‐term (3 to 12 weeks) blood pressure lowering efficacy of hydrochlorothiazide in comparison with other diuretics for primary hypertension in adults, and will build upon the other Cochrane Reviews studying the blood pressure lowering effect of diuretics (Chen 2009; Musini 2009; Musini 2014). The main outcomes of this review will be change in blood pressure, heart rate, and withdrawals due to adverse effects three to 12 weeks after starting the medication.
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Affiliation(s)
| | | | - Parker Jobin
- Faculty of MedicineUniversity of British ColumbiaVancouverCanada
| | - James M Wright
- Department of Anesthesiology, Pharmacology and TherapeuticsUniversity of British ColumbiaVancouverCanada
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Luo HC, Yang ZX, Zhang WF, Tang WL, Li LJ, Chen JMH, Heran BS, Wright JM. Blood pressure lowering efficacy of drugs inhibiting the renin-angiotensin system as second-line therapy for primary hypertension. Hippokratia 2020. [DOI: 10.1002/14651858.cd007188.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hai Chang Luo
- Department of Pharmacology; School of Pharmacy, Fudan University; Shanghai China
| | - Zi Xuan Yang
- Department of Anatomy and Cell Biology, Faculty of Science; McGill University; Montreal Canada
| | - Wei Feng Zhang
- Department of Pharmacology; School of Pharmacy, Fudan University; Shanghai China
| | - Wen Lu Tang
- Department of Pharmacology; School of Pharmacy, Fudan University; Shanghai China
| | - Liang Jin Li
- Department of Pharmacology; School of Pharmacy, Fudan University; Shanghai China
| | - Jenny MH Chen
- Department of Anesthesiology, Pharmacology and Therapeutics; University of British Columbia; Vancouver Canada
| | - Balraj S Heran
- Department of Anesthesiology, Pharmacology and Therapeutics; University of British Columbia; Vancouver Canada
| | - James M Wright
- Department of Anesthesiology, Pharmacology and Therapeutics; University of British Columbia; Vancouver Canada
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Thomford NE, Dzobo K, Chimusa E, Andrae-Marobela K, Chirikure S, Wonkam A, Dandara C. Personalized Herbal Medicine? A Roadmap for Convergence of Herbal and Precision Medicine Biomarker Innovations. ACTA ACUST UNITED AC 2018; 22:375-391. [DOI: 10.1089/omi.2018.0074] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Nicholas Ekow Thomford
- Pharmacogenomics and Drug Metabolism Research Group, Division of Human Genetics, Department of Pathology and Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- School of Medical Sciences, University of Cape Coast, Cape Coast, PMB, Ghana
| | - Kevin Dzobo
- International Centre for Genetic Engineering and Biotechnology, Cape Town component, University of Cape Town, Cape Town, South Africa
- Department of Integrative Biomedical Science, Division of Medical Biochemistry, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Emile Chimusa
- Pharmacogenomics and Drug Metabolism Research Group, Division of Human Genetics, Department of Pathology and Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kerstin Andrae-Marobela
- Molecular Cell Biology, Department of Biological Sciences, University of Botswana, Gaborone, Botswana
| | - Shadreck Chirikure
- Department of Archaeology, University of Cape Town, Cape Town, South Africa
| | - Ambroise Wonkam
- Pharmacogenomics and Drug Metabolism Research Group, Division of Human Genetics, Department of Pathology and Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Collet Dandara
- Pharmacogenomics and Drug Metabolism Research Group, Division of Human Genetics, Department of Pathology and Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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McStea M, McGeechan K, Kamaruzzaman SB, Rajasuriar R, Tan MP. Defining metabolic syndrome and factors associated with metabolic syndrome in a poly-pharmaceutical population. Postgrad Med 2016; 128:797-804. [DOI: 10.1080/00325481.2016.1229103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Megan McStea
- The Malaysian Elders Longitudinal Research (MELoR), University of Malaya, Kuala Lumpur, Malaysia
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - Kevin McGeechan
- Centre for Medical Psychology and Evidence-based Decision-making, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Shahrul Bahyah Kamaruzzaman
- The Malaysian Elders Longitudinal Research (MELoR), University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Reena Rajasuriar
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- The Malaysian Elders Longitudinal Research (MELoR), University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Musini VM, Rezapour P, Wright JM, Bassett K, Jauca CD. Blood pressure-lowering efficacy of loop diuretics for primary hypertension. Cochrane Database Syst Rev 2015; 2015:CD003825. [PMID: 26000442 PMCID: PMC7156893 DOI: 10.1002/14651858.cd003825.pub4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Antihypertensive drugs from the thiazide diuretic drug class have been shown to reduce mortality and cardiovascular morbidity. Loop diuretics are indicated and used to treat hypertension, but a systematic review of their blood pressure-lowering efficacy or effectiveness in terms of reducing cardiovascular mortality or morbidity from randomized controlled trial (RCT) evidence has not been conducted. OBJECTIVES To determine the dose-related decrease in systolic or diastolic blood pressure, or both, as well as adverse events leading to participant withdrawal and adverse biochemical effects (serum potassium, uric acid, creatinine, glucose and lipids profile) due to loop diuretics versus placebo control in the treatment of people with primary hypertension. SEARCH METHODS We searched the Cochrane Hypertension Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, 2014, Issue 9), MEDLINE, MEDLINE In-Process, EMBASE, and ClinicalTrials.gov to 27 October 2014. SELECTION CRITERIA We included double-blind randomized placebo-controlled trials of at least three weeks duration comparing loop diuretic with a placebo in people with primary hypertension defined as blood pressure greater than 140/90 mmHg at baseline. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the risk of bias and extracted data. We used weighted mean difference and a fixed effects model to combine continuous outcome data. We analysed the drop outs due to adverse effects using relative risk ratio. MAIN RESULTS Nine trials evaluated the dose-related blood pressure-lowering efficacy of five drugs within the loop diuretics class (furosemide 40 mg to 60 mg, cicletanine 100 mg to 150 mg, piretanide 3 mg to 6 mg, indacrinone enantiomer -2.5 mg to -10.0/+80 mg, and etozolin 200 mg) in 460 people with baseline blood pressure of 162/103 mmHg for a mean duration of 8.8 weeks. The best estimate of systolic/diastolic blood pressure-lowering efficacy of loop diuretics was -7.9 (-10.4 to -5.4) mmHg/ -4.4 (-5.9 to -2.8) mmHg. Withdrawals due to adverse effects and serum biochemical changes did not show a significant difference.We performed additional searches in 2012 and 2014, which found no additional trials meeting the minimum inclusion criteria. AUTHORS' CONCLUSIONS Based on the limited number of published RCTs, the systolic/diastolic blood pressure-lowering effect of loop diuretics is -8/-4 mmHg, which is likely an overestimate. We graded the quality of evidence for both systolic and diastolic blood pressure estimates as "low" due to the high risk of bias of included studies and the high likelihood of publication bias. We found no clinically meaningful blood pressure-lowering differences between different drugs within the loop diuretic class. The dose-ranging effects of loop diuretics could not be evaluated. The review did not provide a good estimate of the incidence of harms associated with loop diuretics because of the short duration of the trials and the lack of reporting of adverse effects in many of the trials.
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Affiliation(s)
- Vijaya M Musini
- University of British ColumbiaDepartment of Anesthesiology, Pharmacology and Therapeutics2176 Health Science MallVancouverBCCanadaV6T 1Z3
| | - Pouria Rezapour
- University of British ColumbiaFaculty of MedicineVancouverBCCanada
| | - James M Wright
- University of British ColumbiaDepartment of Anesthesiology, Pharmacology and Therapeutics2176 Health Science MallVancouverBCCanadaV6T 1Z3
| | - Ken Bassett
- University of British ColumbiaDepartment of Anesthesiology, Pharmacology and Therapeutics2176 Health Science MallVancouverBCCanadaV6T 1Z3
| | - Ciprian D Jauca
- University of British ColumbiaDepartment of Anesthesiology, Pharmacology and Therapeutics2176 Health Science MallVancouverBCCanadaV6T 1Z3
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Ghosh M, Majumdar SR. Antihypertensive medications, bone mineral density, and fractures: a review of old cardiac drugs that provides new insights into osteoporosis. Endocrine 2014; 46:397-405. [PMID: 24504763 DOI: 10.1007/s12020-014-0167-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 01/04/2014] [Indexed: 01/20/2023]
Abstract
Osteoporosis is increasing in prevalence and importance as society's age, with the clinical consequence of fractures of the hip, spine, and upper extremity, leading to impaired quality of life, loss of function and independence, and increased morbidity and mortality. A major risk factor for osteoporosis is older age, and cardiovascular diseases also share this risk factor; therefore, osteoporosis and cardiovascular disease often coexist and share risk factors. Medications used for the treatment of cardiovascular diseases, in particular antihypertensive drugs, have been shown in a variety of studies of varying designs to modulate bone health in both a positive or negative manner. In this article, we reviewed the pharmacology, potential mechanisms, and possible effects on bone mineral density and fracture risk of commonly prescribed antihypertensive medications, including thiazide and non-thiazide diuretics, beta-blockers, calcium channel blockers, renin-angiotensin-aldosterone system agents, and nitrates.
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Affiliation(s)
- Mahua Ghosh
- Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Musini VM, Nazer M, Bassett K, Wright JM. Blood pressure-lowering efficacy of monotherapy with thiazide diuretics for primary hypertension. Cochrane Database Syst Rev 2014; 2014:CD003824. [PMID: 24869750 PMCID: PMC10612990 DOI: 10.1002/14651858.cd003824.pub2] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hypertension is a modifiable cardiovascular risk factor. Although it is established that low-dose thiazides reduce mortality as well as cardiovascular morbidity, the dose-related effect of thiazides in decreasing blood pressure has not been subject to a rigorous systematic review. It is not known whether individual drugs within the thiazide diuretic class differ in their blood pressure-lowering effects and adverse effects. OBJECTIVES To determine the dose-related decrease in systolic and/or diastolic blood pressure due to thiazide diuretics compared with placebo control in the treatment of patients with primary hypertension. Secondary outcomes included the dose-related adverse events leading to patient withdrawal and adverse biochemical effects on serum potassium, uric acid, creatinine, glucose and lipids. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 1), Ovid MEDLINE (1946 to February 2014), Ovid EMBASE (1974 to February 2014) and ClinicalTrials.gov. SELECTION CRITERIA We included double-blind, randomized controlled trials (RCTs) comparing fixed-dose thiazide diuretic monotherapy with placebo for a duration of 3 to 12 weeks in the treatment of adult patients with primary hypertension. DATA COLLECTION AND ANALYSIS Two authors independently screened articles, assessed trial eligibility, extracted data and determined risk of bias. We combined data for continuous variables using a mean difference (MD) and for dichotomous outcomes we calculated the relative risk ratio (RR) with 95% confidence interval (CI). MAIN RESULTS We included 60 randomized, double-blind trials that evaluated the dose-related trough blood pressure-lowering efficacy of six different thiazide diuretics in 11,282 participants treated for a mean duration of eight weeks. The mean age of the participants was 55 years and baseline blood pressure was 158/99 mmHg. Adequate blood pressure-lowering efficacy data were available for hydrochlorothiazide, chlorthalidone and indapamide. We judged 54 (90%) included trials to have unclear or high risk of bias, which impacted on our confidence in the results for some of our outcomes.In 33 trials with a baseline blood pressure of 155/100 mmHg, hydrochlorothiazide lowered blood pressure based on dose, with doses of 6.25 mg, 12.5 mg, 25 mg and 50 mg/day lowering blood pressure compared to placebo by 4 mmHg (95% CI 2 to 6, moderate-quality evidence)/2 mmHg (95% CI 1 to 4, moderate-quality evidence), 6 mmHg (95% CI 5 to 7, high-quality evidence)/3 mmHg (95% CI 3 to 4, high-quality evidence), 8 mmHg (95% CI 7 to 9, high-quality evidence)/3 mmHg (95% CI 3 to 4, high-quality evidence) and 11 mmHg (95% CI 6 to 15, low-quality evidence)/5 mmHg (95% CI 3 to 7, low-quality evidence), respectively.Direct comparison of doses did not show evidence of dose dependence for blood pressure-lowering for any of the other thiazides for which RCT data were available: bendrofluazide, chlorthalidone, cyclopenthiazide, metolazone or indapamide.In seven trials with a baseline blood pressure of 163/88 mmHg, chlorthalidone at doses of 12.5 mg to 75 mg/day reduced average blood pressure compared to placebo by 12.0 mmHg (95% CI 10 to 14, low-quality evidence)/4 mmHg (95% CI 3 to 5, low-quality evidence).In 10 trials with a baseline blood pressure of 161/98 mmHg, indapamide at doses of 1.0 mg to 5.0 mg/day reduced blood pressure compared to placebo by 9 mmHg (95% CI 7 to 10, low-quality evidence)/4 (95% CI 3 to 5, low-quality evidence).We judged the maximal blood pressure-lowering effect of the different thiazides to be similar. Overall, thiazides reduced average blood pressure compared to placebo by 9 mmHg (95% CI 9 to 10, high-quality evidence)/4 mmHg (95% CI 3 to 4, high-quality evidence).Thiazides as a class have a greater effect on systolic than on diastolic blood pressure, therefore thiazides lower pulse pressure by 4 mmHg to 6 mmHg, an amount that is greater than the 3 mmHg seen with angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and renin inhibitors, and the 2 mmHg seen with non-selective beta-blockers. This is based on an informal indirect comparison of results observed in other Cochrane reviews on ACE inhibitors, ARBs and renin inhibitors compared with placebo, which used similar inclusion/exclusion criteria to the present review.Thiazides reduced potassium, increased uric acid and increased total cholesterol and triglycerides. These effects were dose-related and were least for hydrochlorothiazide. Chlorthalidone increased serum glucose but the evidence was unclear for other thiazides. There is a high risk of bias in the metabolic data. This review does not provide a good assessment of the adverse effects of these drugs because there was a high risk of bias in the reporting of withdrawals due to adverse effects. AUTHORS' CONCLUSIONS This systematic review shows that hydrochlorothiazide has a dose-related blood pressure-lowering effect. The mean blood pressure-lowering effect over the dose range 6.25 mg, 12.5 mg, 25 mg and 50 mg/day is 4/2 mmHg, 6/3 mmHg, 8/3 mmHg and 11/5 mmHg, respectively. For other thiazide drugs, the lowest doses studied lowered blood pressure maximally and higher doses did not lower it more. Due to the greater effect on systolic than on diastolic blood pressure, thiazides lower pulse pressure by 4 mmHg to 6 mmHg. This exceeds the mean 3 mmHg pulse pressure reduction achieved by ACE inhibitors, ARBs and renin inhibitors, and the 2 mmHg pulse pressure reduction with non-selective beta-blockers as shown in other Cochrane reviews, which compared these antihypertensive drug classes with placebo and used similar inclusion/exclusion criteria.Thiazides did not increase withdrawals due to adverse effects in these short-term trials but there is a high risk of bias for that outcome. Thiazides reduced potassium, increased uric acid and increased total cholesterol and triglycerides.
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Affiliation(s)
- Vijaya M Musini
- University of British ColumbiaDepartment of Anesthesiology, Pharmacology and Therapeutics2176 Health Science MallVancouverBCCanadaV6T 1Z3
| | | | - Ken Bassett
- University of British ColumbiaDepartment of Anesthesiology, Pharmacology and Therapeutics2176 Health Science MallVancouverBCCanadaV6T 1Z3
| | - James M Wright
- University of British ColumbiaDepartment of Anesthesiology, Pharmacology and Therapeutics2176 Health Science MallVancouverBCCanadaV6T 1Z3
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Zerm R, Zerm R, Lutnæs-Mast F, Mast H, Girke M, Kröz M. Effects of eurythmy therapy in the treatment of essential arterial hypertension: a pilot study. Glob Adv Health Med 2014; 2:24-30. [PMID: 24381822 PMCID: PMC3833577 DOI: 10.7453/gahmj.2013.2.1.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: Although eurythmy therapy (ET) has been used in the context of anthroposophic medicine (AM) for the treatment of, among other conditions, arterial hypertension (AH) for more than 80 years, there are as yet no studies on its effectiveness on disease entity. However, it has been shown that ET can increase heart rate variability comparably to ergometer training. Objective: To determine whether a 10-week course of ET has an impact on AH and if so, to determine the strength of the effect. The impact of ET on state-autonomic regulation, self-regulation, internal coherence, and quality of life is also explored. Methods: Consecutive inclusion of 9 subjects (6 female, 3 male, mean age of 64 years, SD 8.26) with AH diagnosed by their general practitioners. Inclusion criteria: no or unchanged antihypertensive medication from 4 weeks prior to the start of the study until the end of the study. ET was carried out with weekly instruction along with a daily, home-based program for 10 weeks with specific exercises. Twenty-four–hour blood pressure (BP) measuring was carried out, and the questionnaires were administered before and after the intervention. In addition, after a further 6 months during which 8 of the 9 patients carried on with the exercises of their own accord, the aforementioned parameters were assessed for a third time. Results: Parameters of the 24-hour BP measurements show a moderate, but not significant, improvement immediately after the intervention and 6 months after the intervention. After the 10-week intervention, we saw an improvement of the State-autonomic Regulation questionnaire, the subscale on “Rest/Activity regulation,” of the Self-regulation questionnaire, and the subscale “Initiative and Interest” of the Herdecke Quality of Life Questionnaire (HLQ) (all P < .045). After the 6-month post-study observation period, the aforementioned parameters improved further still, and an additional, significant improvement was seen for the Trait-autonomic Regulation subscale “Rest/Activity regulation,” the HLQ-sum score, and the HLQ subscales “social interaction,” “mental balance,” and “physical ability.” Conclusion: A 10-week course of ET does not result in a significant improvement in BP. The average BP measurements improved post-intervention by an absolute 3.2/2.0 mmHg and after 6 months of independent continuation of ET by 6.3/4.4 mmHg (systolic/diastolic). Despite the small group size, the regulation and quality-of-life parameters improved significantly after the intervention and further still after the 6-month observation period. The results need to be validated with larger patient collectives and control groups.
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Affiliation(s)
| | - Ronald Zerm
- Research Institute Havelhoehe Berlin, Community Hospital Havelhoehe, Berlin, Germany
| | - Froeydis Lutnæs-Mast
- Practice for Eurythmy Therapy at the Ambulatory Healthcare Centre, Zehlendorf, Berlin, Germany
| | - Heiner Mast
- Ambulatory Healthcare Centre, Zehlendorf, Berlin, Germany
| | - Matthias Girke
- Research Institute Havelhoehe Berlin, Community Hospital Havelhoehe, Berlin, Germany
| | - Matthias Kröz
- Research Institute Havelhoehe Berlin, Community Hospital Havelhoehe, Berlin, Germany
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Nedogoda SV, Chumachek EV, Ledyaeva AA, Tsoma AV, Salasyuk AS. COMPARATIVE EFFECTIVENESS OF FIXED-DOSE COMBINATIONS OF LISINOPRIL/AMLODIPINE AND ENALAPRIL/HYDROCHLOROTHIAZIDE. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2013. [DOI: 10.15829/1728-8800-2013-2-25-29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
| | | | | | - A. V. Tsoma
- Volgograd State Medical University, Volgograd
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Heran BS, Chen JMH, Wang JJ, Wright JM. Blood pressure lowering efficacy of potassium-sparing diuretics (that block the epithelial sodium channel) for primary hypertension. Cochrane Database Syst Rev 2012; 11:CD008167. [PMID: 23152254 DOI: 10.1002/14651858.cd008167.pub3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Potassium-sparing diuretics, which block the epithelial sodium channel (ENaC), are widely prescribed for hypertension as a second-line drug in patients taking other diuretics (e.g. thiazide diuretics) and much less commonly prescribed as monotherapy. Therefore, it is essential to determine the effects of ENaC blockers on blood pressure (BP), heart rate and withdrawals due to adverse effects (WDAEs) when given as a first-line or second-line therapy. OBJECTIVES To quantify the dose-related reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP) of ENaC blocker therapy as a first-line or second-line drug in patients with primary hypertension. SEARCH METHODS We searched CENTRAL (The Cochrane Library 2012), MEDLINE (1950 to August 2012), EMBASE (1980 to August 2012) and reference lists of articles. SELECTION CRITERIA Double-blind, randomized, controlled trials in patients with primary hypertension that evaluate, for a duration of 3 to 12 weeks, the BP lowering efficacy of: 1) fixed-dose monotherapy with an ENaC blocker compared with placebo; or 2) an ENaC blocker in combination with another class of anti-hypertensive drugs compared with the respective monotherapy (without an ENaC blocker). DATA COLLECTION AND ANALYSIS Two authors independently assessed the risk of bias and extracted data. Study authors were contacted for additional information. WDAE information was also collected from the trials. MAIN RESULTS No trials evaluating the BP lowering efficacy of ENaC blockers as monotherapy in patients with primary hypertension were identified. Only 6 trials evaluated the BP lowering efficacy of low doses of amiloride and triamterene as a second drug in 496 participants with a baseline BP of 151/102 mm Hg. The additional BP reduction caused by the ENaC blocker as a second drug was estimated by comparing the difference in BP reduction between the combination and monotherapy groups. The addition of low doses of amiloride and triamterene in these trials did not reduce BP. An estimate of the dose-related BP lowering efficacy for ENaC blockers was not possible because of a lack of trial data at higher doses. AUTHORS' CONCLUSIONS ENaC blockers do not have a statistically or clinically significant BP lowering effect at low doses but trials at higher doses are not available. The review did not provide a good estimate of the incidence of harms associated with ENaC blockers.
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Affiliation(s)
- Balraj S Heran
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada.
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11
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Effect of a combined nutraceutical containing Orthosiphon stamineus effect on blood pressure and metabolic syndrome components in hypertensive dyslipidaemic patients: A randomized clinical trial. Complement Ther Clin Pract 2012; 18:190-4. [DOI: 10.1016/j.ctcp.2012.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 02/01/2012] [Accepted: 02/07/2012] [Indexed: 02/06/2023]
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12
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Richter D, Mickel C, Acharya S, Brunel P, Militaru C. Aliskiren-based stepped-care treatment algorithm provides effective blood pressure control. Int J Clin Pract 2011; 65:613-23. [PMID: 21489085 DOI: 10.1111/j.1742-1241.2011.02673.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIMS Recent guidelines for the management of hypertension recommend an individualised stepped-care treatment approach in mild-to-moderate hypertensive patients, to achieve blood pressure (BP) goals. This study evaluated the probability of patients achieving BP targets with an aliskiren-based stepped-care treatment regimen. METHODS This was a 24-week, open-label, non-comparator study design that included six sequential 4-week treatment periods in patients with mild-to-moderate hypertension. Over the potential 24 weeks of active treatment, incremental therapy included the following add-on therapies at 4-week intervals: aliskiren 150-300 mg once daily, hydrochlorothiazide (HCTZ) 12.5-25 mg once daily, and finally amlodipine 5-10 mg once daily, as needed to achieve target BP. Subjects achieving BP targets following any given 4 weeks of therapy were considered study completers, while subjects not achieving their clinical BP target entered into the next step of incremental therapy. The primary efficacy end-point was the estimated cumulative probability of patients achieving BP target. RESULTS Of 256 patients treated, 232 (90.6%) completed the study. Baseline mean sitting BP was 155.7/91.7 mmHg. At study end-point, the estimated cumulative probability of reaching BP target was 86.12%. The stepped-care treatment regimen was well tolerated at the maximal recommended doses of all the individual complimentary therapies. CONCLUSION An aliskiren-based stepped-care treatment regimen that subsequently included both HCTZ and amlodipine is effective in achieving BP goals in approximately 90% of patients with mild-to-moderate hypertension.
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Affiliation(s)
- D Richter
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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13
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Kuriyama S, Otsuka Y, Ueda H, Sugano N, Yoshizawa T, Yamada T, Hosoya T. Augmented antihypertensive effect of a fixed combination formula of candesartan and hydrochlorothiazide combined with furosemide in a patient on peritoneal dialysis. Clin Exp Nephrol 2010; 15:175-8. [DOI: 10.1007/s10157-010-0355-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 09/19/2010] [Indexed: 10/18/2022]
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Reilly RF, Peixoto AJ, Desir GV. The evidence-based use of thiazide diuretics in hypertension and nephrolithiasis. Clin J Am Soc Nephrol 2010; 5:1893-903. [PMID: 20798254 DOI: 10.2215/cjn.04670510] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Thiazide-type diuretics are commonly used in the treatment of hypertension and nephrolithiasis. Evidence from randomized clinical trials needs to be considered in decisions about agent choice and dose. In nephrolithiasis, one of the major limitations of the literature is a paucity of data on the dose-response effect of hydrochlorothiazide (HCTZ) on urinary calcium excretion. The best available evidence for prevention of stone recurrence suggests the use of indapamide at 2.5 mg/d, chlorthalidone at 25 to 50 mg daily, or HCTZ 25 mg twice a day or 50 mg daily. In hypertension, chlorthalidone (12.5 to 30 mg daily) may be the best choice when a diuretic is used for initial therapy, with indapamide (1.5 mg daily) being a valuable alternative for older patients. When adding a thiazide to other drug classes, indapamide (2.5 mg daily) has demonstrated value in hypertensive patients who have had a stroke, and HCTZ (12.5 to 25 mg daily) has a safe track record in several patient groups. Although chlorthalidone has not been tested as add-on therapy, the authors believe it is a safe option in such cases.
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Affiliation(s)
- Robert F Reilly
- VA North Texas Health Care System, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75216, USA.
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Heran BS, Chen JM, Wang JJ, Wright JM. Blood pressure lowering efficacy of potassium-sparing diuretics (that block the epithelial sodium channel) for primary hypertension. Cochrane Database Syst Rev 2010:CD008167. [PMID: 20091662 DOI: 10.1002/14651858.cd008167.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Potassium-sparing diuretics, which block the epithelial sodium channel (ENaC), are widely prescribed for hypertension as a second-line drug in patients taking other diuretics (e.g. thiazide diuretics) and much less commonly prescribed as monotherapy. Therefore, it is essential to determine the effects of ENaC blockers on blood pressure (BP), heart rate and withdrawals due to adverse effects (WDAEs) when given as a first-line or second-line therapy. OBJECTIVES To quantify the dose-related reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP) of ENaC blocker therapy as a first-line or second-line drug in patients with primary hypertension. SEARCH STRATEGY We searched CENTRAL (The Cochrane Library 2009, Issue 3), MEDLINE (1950 to August 2009), EMBASE (1980 to August 2009) and reference lists of articles. SELECTION CRITERIA Double-blind, randomized, controlled trials in patients with primary hypertension that evaluate, for a duration of 3 to 12 weeks, the BP lowering efficacy of: 1) fixed-dose monotherapy with an ENaC blocker compared with placebo; or 2) an ENaC blocker in combination with another class of anti-hypertensive drugs compared with the respective monotherapy (without an ENaC blocker). DATA COLLECTION AND ANALYSIS Two authors independently assessed the risk of bias and extracted data. Study authors were contacted for additional information. WDAE information was also collected from the trials. MAIN RESULTS No trials evaluating the BP lowering efficacy of ENaC blockers as monotherapy in patients with primary hypertension were identified. Only 6 trials evaluated the BP lowering efficacy of low doses of amiloride and triamterene as a second drug in 496 participants with a baseline BP of 151/102 mm Hg. The additional BP reduction caused by the ENaC blocker as a second drug was estimated by comparing the difference in BP reduction between the combination and monotherapy groups. The addition of low doses of amiloride and triamterene in these trials did not reduce BP. An estimate of the dose-related BP lowering efficacy for ENaC blockers was not possible because of a lack of trial data at higher doses. AUTHORS' CONCLUSIONS ENaC blockers do not have a statistically or clinically significant BP lowering effect at low doses but trials at higher doses are not available. The review did not provide a good estimate of the incidence of harms associated with ENaC blockers.
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Affiliation(s)
- Balraj S Heran
- Peninsula Technology Assessment Group (PenTAG), Peninsula College of Medicine & Dentistry, University of Exeter, Noy Scott House, Barrack Road, Exeter, Devon, UK, EX2 5DW
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16
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Chen JM, Heran BS, Perez MI, Wright JM. Blood pressure lowering efficacy of beta-blockers as second-line therapy for primary hypertension. Cochrane Database Syst Rev 2010:CD007185. [PMID: 20091622 DOI: 10.1002/14651858.cd007185.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Beta-blockers are one of the more commonly prescribed classes of anti-hypertensive drugs, both as first-line and second-line. OBJECTIVES To quantify the effect on systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate and withdrawals due to adverse effects of beta-blocker therapy when given as a second-line drug in adult patients with primary hypertension. SEARCH STRATEGY CENTRAL (The Cochrane Library 2009, Issue 2), MEDLINE (1966-Aug 2009), EMBASE (1988-Aug 2009) and bibliographic citations of articles and reviews were searched. SELECTION CRITERIA Double-blind, randomized controlled trials comparing a beta-blocker in combination with a drug from another class of anti-hypertensive drugs compared with that drug alone for a duration of 3 to 12 weeks in patients with primary hypertension were included. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted the data and assessed trial quality of each included study. MAIN RESULTS 20 double-blind RCTs evaluated the BP lowering efficacy of beta-blockers as second-line drug in 3744 hypertensive patients (baseline BP of 158/102 mmHg; mean duration of 7 weeks). The BP reduction from adding a beta-blocker as the second drug was estimated by comparing the difference in BP reduction between the combination and monotherapy groups. A reduction in BP was seen with adding a beta-blocker to thiazide diuretics or calcium channel blockers at doses as low as 0.25 times the manufacturer's recommended starting dose. The BP lowering efficacy of beta-blockers as a second drug was 6/4 mmHg at 1 times the starting dose and 8/6 mmHg at 2 times the starting dose. Beta-blockers reduced heart rate by 10 beats/min at 1 to 2 times the starting dose. Beta-blockers did not statistically significantly increase withdrawals due to adverse effects but this was likely due to the lack of reporting of this outcome in 35% of the included RCTs. AUTHORS' CONCLUSIONS Addition of a beta-blocker to diuretics or calcium-channel blockers reduces BP by 6/4mmHg at 1 times the starting dose and by 8/6 mmHg at 2 times the starting dose. When the blood pressure lowering effect of beta-blockers from this review was compared to that of thiazide diuretics from our previous review (Chen 2009), second-line beta-blockers reduce systolic BP to the same extent as second-line thiazide diuretics, but reduce diastolic BP to a greater degree. The different effect on diastolic BP means that beta-blockers have little or no effect on pulse pressure whereas thiazides cause a significant dose-related decrease in pulse pressure. This difference in the pattern of BP lowering with beta-blockers as compared to thiazides might be the explanation for the fact that beta-blockers appear to be less effective at reducing adverse cardiovascular outcomes than thiazide diuretics, particularly in older individuals.
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Affiliation(s)
- Jenny Mh Chen
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, 2176 Health Sciences Mall, Vancouver, BC, Canada, V6T 1Z3
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17
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El-Zammar DN, Chen JMH, Wright JM. Blood pressure lowering effect of diuretics as second line therapy for primary hypertension in crossover trials. Hippokratia 2010. [DOI: 10.1002/14651858.cd008279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Diala N El-Zammar
- University of British Columbia; Faculty of Medicine; 2176 Health Sciences Mall Vancouver BC Canada V6T 1Z3
| | - Jenny MH Chen
- University of British Columbia; Department of Anesthesiology, Pharmacology and Therapeutics; 2176 Health Sciences Mall Vancouver BC Canada V6T 1Z3
| | - James M Wright
- University of British Columbia; Department of Anesthesiology, Pharmacology and Therapeutics; 2176 Health Sciences Mall Vancouver BC Canada V6T 1Z3
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