[Classical antihypertensive drugs: diuretics]

Area of Science:

• Pharmacology
• Cardiology
• Nephrology

Background:

• Diuretics are fundamental in treating hypertension.
• They effectively lower blood pressure and reduce cardiovascular events.
• Optimal use involves understanding dose-response and specific patient populations.

Purpose of the Study:

• To review the role and optimal use of diuretics in antihypertensive therapy.
• To highlight the benefits and limitations of different diuretic classes.
• To emphasize current trends in diuretic treatment for hypertension.

Main Methods:

• Review of current literature on diuretic use in hypertension.
• Analysis of dose-response relationships for thiazide diuretics.
• Evaluation of specific patient groups benefiting from diuretic therapy.

Main Results:

• Higher doses of thiazides do not improve blood pressure control or reduce cardiovascular events but increase side effects.
• Minimum effective doses and fixed-dose combinations are recommended.
• Diuretics show particular benefit in elderly patients, those with isolated systolic hypertension, heart failure, post-stroke, and in Black populations.
• Loop diuretics are primarily for patients with renal impairment.
• Aldosterone antagonists benefit heart failure and prevent atrial fibrillation, reducing hypokalemia risk when combined with thiazides.

Conclusions:

• Diuretic therapy remains a cornerstone of hypertension management.
• Personalized selection and dosing of diuretics are crucial for efficacy and safety.
• Combination therapy, particularly with aldosterone antagonists, offers enhanced benefits and risk mitigation.