INDICES> Efficacy of low-dose HCTZ in hypertension

["SUE BURTON" <pasb@warthog.ru.ac.za>]

INDICES: Efficacy of low-dose HCTZ in hypertension
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Dear All,

We are trying  to address the issue of hydrochlorothiazide induced 
electrolyte disturbances and particularly increases in serum uric 
acid levels at  the local hospital and PHC clinics in Grahamstown.  
In our clinics the mainstay of hypertensive therapy remains, HCTZ, 
reserpine and methyldopa. 

At present patients are usually started on 25mg of HCTZ daily, then 
a combination HCTZ 50mg and amiloride 5mg (amiloretic Co), before 
reserpine or methyldopa is added. Many of the patients complain of 
sore joints, and are put on NSAIDs - ibuprofen and indomethacin 
particularly.  Often  when investigated raised serum uric levels are 
found to be a problem and allopurinol is added to the 
regimen. Obviously there are problems with the use of NSAIDs in the 
hypertensive patients because of their effects on renal sodium 
handling as well as vascular tone due to inhibition of vasodilator PG 
synthesis. 

Our concerns in this respect are twofold - the patient compliance 
with medication is porr because regimens become very complex, and the 
patients percieve that medication does more harm than good and the 
other concern obviously being a financial one.

A literature search revealed that there is literature which suggests 
that while the effects on uric acid levels with HCTZ is dose 
dependent the magnitude of blood pressure lowering with a lower dose 
12.5mg /day is similar to that obtained with higher doses. 

Does anyone have any experience of this in practice or any other 
advice they can offer or any literature which you can point us 
toward.

Thanking you in advance

Sue Burton
SCHOOL OF PHARMACEUTICAL SCIENCES
RHODES UNIVERSITY
GRAHAMSTOWN
SOUTH AFRICA
6140 
TEL +27+461+318395   FAX +27+461+311205
E-MAIL PASB@WARTHOG.RU.AC.ZA
 

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