Diuretic therapy of hypertension in the United States: Low-dose becomes lower

B. J. Materson

Research output: Contribution to journalReview articlepeer-review

5 Scopus citations


In the USA, thiazide diuretics yielded their pre-eminence as first line antihypertensive therapy to a shared role with beta-blockers in 1984, and with beta-blockers, angiotensin-converting enzyme inhibitors, and calcium channel blockers in 1988. In 1993, The Joint National Committee for the Detection, Evaluation, and Treatment of Hypertension (JNC) partially reversed their 1988 recommendations by making diuretics and beta-blockers the preferred first line antihypertensive therapy. This recommendation was based on decreased cardiovascular events using these drugs and the absence of similar data for the newer drugs. The JNC position does not represent a national consensus. Lower and lower doses of diuretics have proven to be efficacious with an increased margin of safety; e.g. once-daily doses of chlorthalidone 15 mg, hydrochlorothiazide 12.5 mg alone and 6.25 mg in combination, metolazone 0.5 mg, and indapamide 1.25 mg. Hyperuricemia is rarely discussed as an important risk of diuretics, much of the diatribe on increased ventricular arrhythmias with hypokalemia has abated, data showing little or no long-term perturbation of plasma lipids are appearing, and even the insulin sensitivity story is changing. In controlled clinical trials, diuretics still hold their own as safe and effective therapy. Finally, the combination of a diuretic with a non-diuretic drug is more likely to be efficacious than the combination of two non-diuretic drugs.

Original languageEnglish (US)
Pages (from-to)33-45
Number of pages13
JournalProgress in Pharmacology and Clinical Pharmacology
Issue number3
StatePublished - Jan 1 1995

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology


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