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Chen JMH et al. – Fifty–six trials were found. Fifty–three trials involved thiazide diuretics (92% with the drug hydrochlorothiazide) and included a total of 15310 participants. Thiazides when given as a second–line drug have a dose related effect to lower blood pressure that is similar to when they are added as a first–line drug. This means that the BP lowering effect of thiazides is additive. Loop diuretics appear to have a similar blood pressure lowering effect as thiazides at 1 times the recommended starting dose. Because of the short duration of the trials and lack of reporting of adverse events, this review does not provide a good estimate of the incidence of adverse effects of diuretics given as a second–line drug.

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