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Evidence-based diuretic therapy for improving cardiovascular prognosis in systemic hypertension
Firas J Al Badarin1, Mohammad A Abuannadi, Carl J Lavie
1Mid America Heart and Vascular Institute, Saint Luke's Hospital and University of Missouri-Kansas City, Kansas City, Missouri, USA.
The American Journal of Cardiology
|February 15, 2011
Summary
Hydrochlorothiazide is a common hypertension diuretic, but evidence suggests chlorthalidone, indapamide, and aldosterone blockers may offer superior cardiovascular outcomes. Prescribing patterns often do not align with this evidence.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Management
Background:
- Diuretics are frequently prescribed cardiovascular medications for hypertension.
- Evidence for diuretic effectiveness in blood pressure reduction and preventing adverse cardiovascular events varies by class and agent.
- Current prescribing habits among US physicians may not align with evidence-based diuretic therapy for cardiovascular prognosis.
Purpose of the Study:
- To evaluate the comparative effectiveness of different diuretic classes and agents in hypertension management.
- To highlight discrepancies between current prescribing practices and evidence regarding diuretic therapy for cardiovascular outcomes.
Main Methods:
- Review of evidence supporting diuretic effectiveness in hypertension.
- Analysis of prescribing habits among American physicians.
- Comparison of outcomes data for various diuretic agents.
Main Results:
- Significant variation exists in the evidence base for different diuretic classes and agents.
- Hydrochlorothiazide is the standard, but outcomes data suggest potential superiority of other agents.
- Prescribing patterns for hypertension diuretics do not consistently reflect the available evidence.
Conclusions:
- Chlorthalidone, indapamide, and aldosterone receptor blockers (spironolactone, eplerenone) may be superior to hydrochlorothiazide for improving cardiovascular prognosis in hypertension.
- There is a need to align clinical practice with evidence regarding optimal diuretic selection for hypertension management.
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