The place of diuretics in preventing cardiovascular events.
Low-dose diuretics are recommended for the initial choice of antihypertensive therapy in the 7th US Joint National Committee report and are accepted as an appropriate choice among other classes of drugs in the 2003 European Society of Hypertension guidelines. The rationales for the use of low-dose diuretics include the following: Renal dysfunction interfering with normal natriuresis is likely a fundamental defect in the pathogenesis of hypertension. Subtle renal insufficiency that interferes with sodium excretion is a common consequence of uncontrolled hypertension. Diuretic-based therapy has been clearly documented in placebo-controlled, randomized trials to reduce cardiovascular morbidity and mortality, particularly in the treatment of elderly hypertensives.In multiple comparative trials, diuretic-based therapy has been shown to provide equal cardiovascular protection to that provided by newer agents. Diuretics enhance the antihypertensive efficacy of all other classes of agents. As lower blood pressure goals of therapy have been found to be needed, diuretic enhancement of other agents' efficacy has become even more essential. With such low doses, side effects are minimal in degree and infrequent in appearance.
Kaplan
N M
NM
The University of Texas Southwestern Medical Center, Dallas, TX 75235-8899, USA. norman.kaplan@utsouthwestern.edu
D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001581:Benzothiadiazines; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003692:Delayed-Action Preparations; D004232:Diuretics; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007684:Kidney Tubules / Q000187:drug effects / Q000378:metabolism; D015201:Meta-Analysis as Topic; D016032:Randomized Controlled Trials as Topic; D049993:Sodium Chloride Symporter Inhibitors / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D001581:Benzothiadiazines; D003692:Delayed-Action Preparations; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors