title: Should thiazide diuretics be given as first line antihypertensive therapy or in addition to other medications?
abstract: BACKGROUND
  The recommendation to start antihypertensive therapy with diuretics (D) might produce delay in blood pressure (BP) control and, possibly, increase cost/benefit ratio.
  
  
  OBJECTIVE
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: Hypertension Research Center, Federico II University Hospital, via S. Pansini 5, bld. 2, 80131, Naples, Italy.
authors: Valentina
authors: V
authors: Trimarco
authors: Raffaele
authors: R
authors: Izzo
authors: Teresa
authors: T
authors: Migliore
authors: Francesco
authors: F
authors: Rozza
authors: Marina
authors: M
authors: Marino
authors: Maria Virginia
authors: MV
authors: Manzi
authors: Marina
authors: M
authors: De Marco
authors: Giovanni
authors: G
authors: de Simone
authors: Nicola
authors: N
authors: De Luca
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002752:Chlorthalidone / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D058006:General Practice; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D007558:Italy; D008297:Male; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D049993:Sodium Chloride Symporter Inhibitors; D002752:Chlorthalidone