Role of diuretics in treatment of essential hypertension

Oral diuretics have traditionally been first-line (step 1) agents for initiating antihypertensive therapy in the stepped-care approach to management. They have a generally favorable side effects profile as well as several other attributes that make them particularly useful in this role. They are effective as monotherapy in many patients, convenient, easy to titrate, comparatively inexpensive and are well tolerated by most patients. They do not cause salt and water retention, which can lead to pseudotolerance. Monotherapy with a diuretic adequately controls hypertension in many patients with mild hypertension (diastolic blood pressure between 90 and 104 mm Hg). When therapy is initiated with a nondiuretic agent and an additional drug is needed, a diuretic can be used to advantage as step 2 in many patients.