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Should a diuretic always be the first choice in patients with essential hypertension? The case for no

Alberto Morganti1

  • 1Cattedra di Medicina Interna and Centro Ipertensione Arteriosa, Ospedale S. Paolo, University of Milan, Milan, Italy. alberto.morganti@unimi.it

Journal of the American Society of Nephrology : JASN
|June 7, 2005
PubMed

Insights

Diuretics are recommended for hypertension but have drawbacks like metabolic changes and system activation. Optimal blood pressure control, not just the drug, should be the priority for patient outcomes.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Recent trials recommend diuretics as first-line hypertension treatment.
  • Diuretics, however, present significant drawbacks impacting their efficacy and safety.

Purpose of the Study:

  • To evaluate the limitations of diuretics in hypertension management.
  • To discuss the implications of these limitations on patient outcomes and treatment costs.

Main Methods:

  • Review of mechanistic and interventional trials on diuretic effects.
  • Analysis of contraindications and adverse effects of diuretics.

Main Results:

  • Diuretics can activate the renin-angiotensin-aldosterone system, leading to negative cardiovascular effects.
  • Metabolic alterations in glucose, lipid, and potassium metabolism are associated with diuretic use.
  • These limitations can negatively impact clinical outcomes, patient compliance, and therapy costs.

Conclusions:

  • The limitations of diuretics may hinder optimal blood pressure control.
  • Emphasis should be placed on achieving target blood pressure rather than solely on the choice of first-line drug.
  • Alternative therapeutic strategies may be necessary for certain patient populations or clinical conditions.

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