Diuretics in the treatment of hypertension : Efficacy, safety and tolerability.
Summary of "Diuretics in the treatment of hypertension : Efficacy, safety and tolerability."
In the treatment of hypertension, both the thiazide diuretics hydrochlorothiazide and bendroflumethiazide and the "thiazide-like" diuretics chlorthalidone and indapamide are used. Guidelines refer to these as the class of thiazide diuretics suggesting their interchangeability. However, bendroflumethiazide and hydrochlorothiazide, at least in the commonly used low dose range, are less potent with respect to blood pressure lowering and may also be less effective in preventing morbidity and mortality events. This is of great clinical relevance since hydrochlorothiazide is by far the most widely prescribed diuretic. Increasing the dose of hydrochlorothiazide would further reduce tolerability of treatment due to an increase in dose-dependent side effects. The underlying mechanisms of the suggested superiority of chlorthalidone on cardiovascular morbidity and mortality remain unclear. The half-life of chlorthalidone has been estimated at >50 h thus exceeding the half-life of hydrochlorothiazide by about 5-fold. Given the documented irregular intake of antihypertensive drugs, the prolonged efficacy of chlorthalidone makes this agent a "forgiving drug" with a definite advantage over hydrochlorothiazide. On the basis of the available evidence, whenever diuretic treatment is indicated in a hypertensive patient, a thiazide-like agent, preferably chlorthalidone should be employed.
Affiliation
Medizinische Klinik und Poliklinik I, Universitätsklinikum, Wilhelmstraße 35-37, 53111, Bonn, Deutschland, duesing@uni-bonn.de.
Journal Details
This article was published in the following journal.
Name: Der Internist
ISSN: 1432-1289
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21833757
- DOI: http://dx.doi.org/10.1007/s00108-011-2915-3
Medical and Biotech [MESH] Definitions
Antihypertensive Agents
Drugs used in the treatment of acute or chronic vascular HYPERTENSION regardless of pharmacological mechanism. Among the antihypertensive agents are DIURETICS; (especially DIURETICS, THIAZIDE); ADRENERGIC BETA-ANTAGONISTS; ADRENERGIC ALPHA-ANTAGONISTS; ANGIOTENSIN-CONVERTING ENZYME INHIBITORS; CALCIUM CHANNEL BLOCKERS; GANGLIONIC BLOCKERS; and VASODILATOR AGENTS.
Treatment Outcome
Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series.
Therapeutic Equivalency
The relative equivalency in the efficacy of different modes of treatment of a disease, most often used to compare the efficacy of different pharmaceuticals to treat a given disease.
Safety
Freedom from exposure to danger and protection from the occurrence or risk of injury or loss. It suggests optimal precautions in the workplace, on the street, in the home, etc., and includes personal safety as well as the safety of property.
Materials Testing
The testing of materials and devices, especially those used for PROSTHESES AND IMPLANTS; SUTURES; TISSUE ADHESIVES; etc., for hardness, strength, durability, safety, efficacy, and biocompatibility.
PubMed Articles
Diuretics and ultrafiltration in acute decompensated heart failure.
Congestion and volume overload are the hallmarks of acute decompensated heart failure (ADHF), and loop diuretics have historically been the cornerstone of treatment. The demonstrated efficacy of loop...
Imidafenacin for the treatment of overactive bladder.
Introduction: Imidafenacin (KRP-197/ONO-8025) is the latest antimuscarinic (AM) developed for the treatment of overactive bladder syndrome (OAB) and, at the moment, it is marketed only in Japan. This...
Many patients with hypertension will require multiple antihypertensive drugs to achieve blood pressure (BP) control. This double-blind study evaluated the efficacy and safety of aliskiren/amlodipine s...
Use of diuretics in patients with hypertension.
Use of Diuretics in Patients with Hypertension Review Article, N Engl J Med 2009;361:2153-2164. In Table 3 (page 2161), under "Possible Solution," the parenthetical information in the entry beginning,...
Experience with imidafenacin in the management of overactive bladder disorder.
Overactive bladder (OAB) is a chronic syndrome defined by symptoms of urinary urgency with no underlying medical causes. First-line treatment of OAB comprises fluid intake advice and bladder training,...
Clinical Trials
Diuretics In the Management of Essential Hypertension (DIME) Study
The purpose of DIME is to evaluate the safety (i.e. new onset of diabetes and other metabolic adverse events), efficacy and cost-effectiveness of antihypertensive treatment with low dose d...
Calcium Channel Blockers (CCBs) or Diuretics as an Add-on to Olmesartan Medoxomil in Hypertension
The purpose of the study is to test the efficacy and safety of the combination of Calcium Channel Blockers (CCBs)(of the dihydropyridine class) or Diuretics (of the thiazide class) and olm...
The purpose of this study is to investigate which combination therapy is more effective for improving the blood pressure (BP) and reducing target organ damage in Japanese hypertensive pati...
PHARES Study: Management of Resistant Hypertension
The purpose of this study is to assess the efficacy of two different treatment regimens for treating resistant hypertension previously uncontrolled with at least 3 antihypertensive treatme...
Diuretics, Hypertension, and Arrhythmias Clinical Trial
To determine whether hypertensive patients with ECG abnormalities and receiving hydrochlorothiazide diuretics were at increased risk of sudden death.
