The place of diuretics in the treatment of hypertension in 1993: can we do better?

Diuretics are the only class of antihypertensive drugs that have been conclusively shown to reduce morbidity and mortality in long term outcome trials. However even in these trials there were difficulties with withdrawals, cross contamination, high usage of 2 or more drugs and adverse effects. Low doses of thiazide diuretics should be recommended because they have equal blood pressure lowering effects with less biochemical changes and adverse reactions. In 3 of the 4 outcome trials in the elderly in which there were significant reductions in cardiovascular morbidity and mortality a potassium sparing agent was used in conjunction with the thiazide diuretic, raising the possibility of additional cardioprotection.