Prevalence, awareness, treatment and control of hypertension in elderly Chinese
Chang‐Sheng ShengMing LiuYuan‐Yuan KangFang‐Fei WeiLu ZhangGe-Le LiQian DongQi‐Fang HuangYan LiJi‐Guang Wang
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Keywords:
Sitting
Antihypertensive drug
Thiazide
Calcium channel blocker
Stepwise regression
Thiazide diuretics are the cornerstone of treatment of hypertension in most patients. Hydrochlorothiazide is the most commonly used thiazide diuretic in the United States, but interest in chlorthalidone is increasing. The authors summarize the literature comparing these two agents.
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Benzothiadiazines
Chlorothiazide
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Hydrochlorothiazide, a drug which is often initially prescribed for mild to moderate hypertension, failed to lower blood pressures in 9 of 43 patients but concomitantly elevated plasma norepinephrine (NE) levels in all patients with hypertension. 20 The 9 obese hydrochlorothiazide-resistant patients were then given fenfluramine, an anorectic, in addition to the thiazide. They were reevaluated after 2 and 5 wk, at which times there were reductions in blood pressures and marked reductions in the plasma NE levels which had been elevated by the hydrochlorothiazide. Since iatrogenic sympathetic activation seems undesirable in treating hypertension, fenfluramine may be useful in obese thiazide-resistant hypertensive patients when used in combination with a thiazide diuretic. Clinical Pharmacology and Therapeutics (1980) 28, 22–27; doi:10.1038/clpt.1980.125
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Clinical Pharmacology
Chlorothiazide
Essential hypertension
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Introduction: Thiazide diuretics are among the major anti-hypertensive medications. Hydrochlorothiazide and indapamide are among the most commonly used thiazides. Common side effects include impaired renal function and electrolyte disturbances. Whether hydrochlorothiazide and indapamide cause the same amount of disturbance at equivalent doses is uncertain.
Methodology: Patient data from four different clinics was analyzed. Patients whose thiazide diuretic was initiated or dose escalated were included if they met the inclusion criteria. Patient characteristics, including demographics, comorbidities, medications, renal function, and electrolyte values at the initial visit and control visit, and hydrochlorothiazide or indapamide exposure per milligram, were acquired. Indapamide doses were multiplied by ten to convert into equivalent thiazide doses. Changes in renal function and electrolyte values, and renal function and electrolyte changes per equivalent thiazide exposure, were calculated.
Results: The uric acid increase and potassium decrease were different for the indapamide and hydrochlorothiazide groups. However, when these changes were analyzed per equivalent thiazide exposure, potassium was not different, but the uric acid increase was still significantly different between indapamide and hydrochlorothiazide (.05(.08) vs .03 (.08) mg/dL per equivalent mg thiazide, p = .049).
Discussion: This study demonstrated that indapamide’s hyperuricemic effect is more profound than that of hydrochlorothiazide. Choosing hydrochlorothiazide instead of indapamide may be more appropriate in patients with higher initial uric acid levels.
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In a double-blind study comprising 31 patients with essential hypertension not satisfactorily controlled on hydrochlorothiazide 25 mg o.m., a fixed-ratio combination of metoprolol 100 mg and hydrochlorothiazide 12.5 mg, given as 2 tablets o.m. has been compared with hydrochlorothiazide 50 mg o.m. monotherapy. With the combination regimen a significant reduction of blood pressure was achieved while doubling of the thiazide dose did not adequately control the blood pressure. In 7 patients in the thiazide-group the therapy was changed to the combination during a follow-up period and their blood pressure was normalised. During the follow-up period, 22 patients were thus treated with the fixed combination; 50% of them were controlled on one tablet o.m. The tolerability was good in both groups and no changes were observed regarding laboratory variables except for an increase in serum uric acid in the thiazide-group. The study indicates that a fixed-ratio combination of hydrochlorothiazide 12.5 mg and metoprolol 100 mg in a dose of one or two tablets once daily is a well tolerated and more effective therapy than hydrochlorothiazide 50 mg once daily monotherapy.
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Plasma renin activity
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Hydrochlorothiazide and other thiazide-like diuretics are considered as a first-line drug for initial therapy in uncomplicated arterial hypertension [1]. There are several reports [2–6] of thiazide-induced cholecystitis, but here we report a case of serious hepatotoxicity associated with hydrochlorothiazide treatment.
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Is hydrochlorothiazide (HCTZ) a better choice than chlorthalidone for hypertension?
No trials compare HCTZ with other thiazide diuretics in terms of cardiovascular or mortality outcomes. We must rely on less rigorous study designs and other outcomes.
Available data suggest HCTZ is at best equal
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The effect of chronic hydrochlorothiazide administration on the composition of renal papillary interstitial fluid was investigated in the rat. Hydrochlorothiazide alone had no effect on papillary composition. However, when the sodium depletion that usually accompanies thiazide treatment was minimized by allowing the rats access to hypertonic NaCl solution, hydrochlorothiazide administration resulted in significant reductions in papillary osmolality, and sodium and potassium concentrations. It is suggested that the effects of hydrochlorothiazide on the renal papilla might be mediated by thiazide-induced hypokalaemia, and that under normal circumstances these effects are masked by the concomitant sodium depletion.
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Interstitial fluid
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