Diuretics: correct use in hypertension

The use of diuretics for the treatment of hypertension had fallen significantly from 1990 until 1997, when their use again began to increase. Their recent return to popularity reflects 3 major factors: (1) the recognition of the effectiveness of much lower doses than used previously, thereby providing good antihypertensive action with fewer side effects; (2) the excellent reductions in morbidity and mortality achieved by low-dose diuretic-based therapy in multiple, randomized controlled trials in elderly hypertensives; and (3) the increasing recognition that some diuretic-induced shrinkage of effective blood volume is essential for adequate treatment of many, if not most, hypertensives.