Back to thiazide-diuretics for hypertension: reflections after a decade of irrational prescribing.
BACKGROUND
Whether newer antihypertensive drugs, such as calcium channel blockers, angiotensin converting enzyme inhibitors and alpha blockers are more effective than thiazides and beta blockers in preventing coronary disease, has been debated for years.


CONCLUSIONS
Recently several trials addressing this issue have been finalised, and they provide a convincing answer: the newer drugs are no better than the older ones. In the largest trial to date (ALLHAT), thiazide-type diuretic was found to offer advantages over newer drugs. The medical community should now be capable of reaching consensus, and recommend thiazides as the first line therapy for the treatment of hypertension. Prescribing physicians, cardiologists, drug companies and health authorities are all partly responsible for the years of irrational prescribing that we have witnessed.


CONCLUSIONS
All stakeholders should now contribute in order to achieve what is clearly in the public's interest: implementing the use of thiazides in clinical practice.
Fretheim
Atle
A
Department of Health Services Research, Norwegian Directorate for Health and Social Affairs, N-0031 Oslo, Norway. atle.fretheim@shdir.no
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001581:Benzothiadiazines; D002986:Clinical Trials as Topic; D004232:Diuretics; D011307:Drug Prescriptions; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use*
D000959:Antihypertensive Agents; D001581:Benzothiadiazines; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors