Increasing the dose of a thiazide diuretic used alone in patients with essential hypertension has little further effect on blood pressure but increases the deleterious metabolic consequences of the diuretic. The effect of a beta-blocker on this flat dose response is not known. In two randomised crossover studies the effect of 12.5 mg, 25 mg, and 50 mg hydrochlorothiazide combined with 400 mg acebutolol was assessed. The mean fall in supine blood pressure was about 15% and was the same whatever dose of thiazide was used with the beta-blocker. As the dose of hydrochlorothiazide was increased, however, there was evidence of increasing metabolic consequences of the diuretic. The study did not define the minimum dose of diuretic, and doses of hydrochlorothiazide lower than 12.5 mg might be as effective. These results suggest that many patients who are being treated with a combination of a beta-blocker and a diuretic are receiving unnecessarily large amounts of the diuretic without benefit to their blood pressure and with adverse metabolic consequences.
Propranolol inhibition of renin secretion. A specific approach to diagnosis and treatment of renin-dependent hypertensive diseases
Captopril in essential hypertension; contrasting effects of adding hydrochlorothiazide or propranolol
Multicentre comparison of the antihypertensive effect of acebutolol and hydrochlorothiazide in uncomplicated mild-moderate hypertension in the elderly
The influence of cardiovascular and antiinflammatory drugs on thiazide-induced hemodynamic and saluretic effects
Antihypertensive drugs: individualized analysis and clinical relevance of kinetic-dynamic relationships
Pharmacokinetic-pharmacodynamic modeling of the antihypertensive effect of eprosartan in Black and White hypertensive patients
Evolution of diuretics and ACE inhibitors, their renal and antihypertensive actions--parallels and contrasts
Comparison of the antihypertensive efficacy and adverse reactions to two doses of bendrofluazide and hydrochlorothiazide and the effect of potassium supplementation on the hypotensive action of bendrofluazide: substudies of the Medical Research Council's trials of treatment of mild hypertension: Medical Research Council Working Party
Treating hypertension in non-insulin-dependent diabetes: a comparison of atenolol, nifedipine, and captopril combined with bendrofluazide
Comparison of hydrochlorothiazide and sustained-release diltiazem for mild-to-moderate systemic hypertension
Monotherapy with the calcium channel antagonist nisoldipine for systemic hypertension and comparison with diuretic drugs
The spironolactone, amiloride, losartan, and thiazide (SALT) double-blind crossover trial in patients with low-renin hypertension and elevated aldosterone-renin ratio
Therapeutic progress--review XXII. Are we making progress in the treatment of hypertension in the elderly?
Treatment of essential hypertension with beta-blocker plus diuretic: a study of 1402 patients treated by general practitioners with acebutolol 200 mg combined with hydrochlorothiazide 12.5 mg ('Secadrex') once daily for 3 months
Antihypertensive and biochemical effects of different doses of hydrochlorothiazide alone or in combination with triamterene
Chlorthalidone alone or in fixed combination with slow-release metoprolol in the management of arterial hypertension: a long-term study of 545 patients
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