Effectiveness of low-dose diuretics for blood pressure reduction to optimal values in prehypertension: a randomized clinical trial. Issue 4 (April 2018)

• Record Type: Journal Article
• Authors: Fuchs, Flávio D.; Fuchs, Sandra C.; Poli-de-Figueiredo, Carlos E.; Figueiredo Neto, José A.; Scala, Luiz César N.; Vilela-Martin, José F.; Moreira, Leila B.; Chaves, Hilton; Mota Gomes, Marco; de Sousa, Marcos R.; Silva, Ricardo Pereira e; Castro, Iran; Cesarino, Evandro José; Sousa, Ana Luiza Lima; Alves, João Guilherme; Steffens, André Avelino; Brandão, Andréa Araujo; Bortolotto, Luiz Aparecido; Afiune Neto, Abrahão; Nóbrega, Antônio C.; Franco, Roberto Silva; Sobral Filho, Dario C.; Nobre, Fernando; Schlatter, Rosane; Gus, Miguel; De David, Caroline Nespolo; Rafaelli, Leticia; Sesin, Guilhermo Prates; Berwanger, Otávio; Whelton, Paul K.
• Is Part Of: Journal of hypertension. Volume 36:Issue 4(2018:Apr.)
• Publication Date: 2018-04
• Subjects: chlorthalidone and amiloride -- clinical trials -- hypertension -- optimal blood pressure -- prehypertension; Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/HJH.0000000000001624
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Background: To determine the effectiveness of low-dose diuretic therapy to achieve an optimal level of blood pressure (BP) in adults with prehypertension. Methods: The PREVER-prevention trial was a randomized, parallel, double-blinded, placebo-controlled trial, with 18 months of follow-up, conducted at 21 academic medical centers in Brazil. Of 1772 individuals evaluated for eligibility, 730 volunteers with prehypertension who were aged 30–70 years, and who did not reach optimal blood pressure after 3 months of lifestyle intervention, were randomized to a fixed association of chlorthalidone 12.5 mg and amiloride 2.5 mg or placebo once a day. The main outcomes were the percentage of participants who achieved an optimal level of BP. Results: A total of 372 participants were randomly allocated to diuretics and 358 to placebo. After 18 months of treatment, optimal BP was noted in 25.6% of the diuretic group and 19.3% in the placebo group ( P < 0.05). The mean net reduction in SBP and DBP for the diuretic group compared with placebo was 2.8 mmHg (95% CI 1.1 to 4.5) and 1.1 mmHg (95% CI −0.09 to 2.4), respectively. Most participants in the active treatment group (74.5%) and in the placebo group (80.7%) continued to have BP in the prehypertension range or progressed to hypertension. Conclusion: Low-dose diuretic therapy increased the probability of individuals with prehypertension to achieve optimal BP but most of those treated continued to have a BP in the prehypertension range or progressed to having overt hypertension.