As monotherapy, diuretics are as efficacious as drugs from each of the other commonly used classes of antihypertensive drugs - alpha and beta blockers, ACE inhibitors, calcium channel antagonists and `centrally acting' drugs - L.M.H. Wing


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Is there a place for thiazide diuretics in the management of hypertension?

As newer antihypertensive drugs have been introduced and heavily promoted for the treatment of hypertension, the continuing role of the thiazide diuretics has been questioned. This questioning is fuelled by a popular misconception that thiazides are not as potent as other antihypertensives, have unacceptable biochemical adverse effects and are associated with negative effects on cardiovascular risk factors such as increases in plasma cholesterol and impairment of glucose tolerance. The image of diuretics as antihypertensive drugs has not been helped by their lack of promotion by the pharmaceutical industry.

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 Is there a place for thiazide diuretics in the management of hypertension?

Apart from the now uncommon situation of excessive drug-induced salt and water retention, thiazides are more effective and better tolerated as antihypertensives than the more potent loop diuretics.


The usual initial dose in adults is 25 mg daily given as a single dose. The dose may be increased to 50 mg daily, given as a single or two divided doses.


Site of action is at early distal tubule where they block electroneutral Na-Cl co-transport resulting in a modest increase in Na excretion (NB. 90% Na already reabsorbed!).


Different thiazide drugs have similar effects in lowering blood pressure and thiazides lower systolic blood pressure more than other classes of antihypertensive drugs.


Thiazide diuretics are an FDA-approved class of drugs that inhibit the reabsorption of 3% to 5% of luminal sodium in the distal convoluted tubule of the nephron. By doing so, thiazide diuretics promote natriuresis and diuresis. Three thiazide diuretics are the most commonly used: hydrochlorothiazide (HCTZ), chlorthalidone, and indapamide.

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