Metabolic side effects and cardiovascular events of diuretics: should a diuretic remain the first choice therapy in hypertension treatment? The case of yes.
Essential hypertension is a major cause of cardiovascular morbidity and mortality in the Western world. Numerous clinical trials have demonstrated that the treatment of hypertension results in a substantial reduction of hypertension-related morbidity and mortality. The efficacy and safety of diuretics has been shown in many clinical trials. Like most other antihypertensive agents, the side effects of diuretics are mostly benign and mild. The metabolic side effects of diuretics, however, have been a bone of contention for a long time. In this paper, we describe the most important and frequent metabolic side effects of diuretics, and emphasize particularly the non-life-threatening effect of diuretics on ventricular arrhythmias due to their hypokalemic effect, the detection of the new onset diabetes (perhaps caused by the administration of diuretics itself), and their significant beneficial effect on cardiovascular and cerebrovascular morbidity and mortality. At the end of the article, we highlighted the differences regarding the prescription of diuretics between the recently published American and European Guidelines of hypertension.
Hypertension and Cardiovascular Research Clinic, Georgetown University, Washington, DC, USA. jimpapdoc@yahoo.com
Dimitris P
DP
Papadopoulos
Vasilios
V
Papademetriou
D001145:Arrhythmias, Cardiac / Q000209:etiology; D002318:Cardiovascular Diseases / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000401:mortality; D002784:Cholesterol / Q000097:blood; D003920:Diabetes Mellitus / Q000139:chemically induced*; D004232:Diuretics / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007008:Hypokalemia / Q000139:chemically induced* / Q000150:complications; D008297:Male; D011188:Potassium / Q000097:blood
D004232:Diuretics; D002784:Cholesterol; D011188:Potassium