Diuretics in the treatment of hypertension

With 30 years of experience, it is possible to claim that diuretics are well tolerated antihypertensive drugs producing a significant decrease in systolic and diastolic blood pressure as good as obtained with beta-blockers, converting enzyme inhibitors, calcium antagonists and centrally acting drugs. Recently diuretics have been criticised because of a substantial number of important side-effects, and are disregarded by some authors as first-line agents for the treatment of mild hypertension. Diuretics seem however safe in the majority of hypertensive patients who do not present special problems. Using low doses, which are equally effective, most toxic properties can probably be avoided. Combination therapy, especially with ACE inhibitors, has not only additional effects, but lowers also the potential adverse effects, caused by diuretics. We are convinced that diuretics are still important as first-line agents for the treatment of arterial hypertension in the general population.