THIAZIDE DIURETICS IN THE MANAGEMENT OF HYPERTENSION
Main Article Content
Keywords
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Abstract
Hypertension is highly prevalent in Canada, affecting more than 20% of all adults.1 Thiazide diuretics have been shown in numerous studies to be effective agents for controlling blood pressure and reducing cardiovascular disease and death in hypertensive patients.2 Thiazide diuretics are recommended as initial first line therapy for uncomplicated hypertension in the 2003 Canadian Hypertension recommendations.3 However, these agents are underutilized and in Canada, the proportion of persons with hypertension treated with diuretics is declining.4 To improve understanding of thiazide diuretic use, this document outlines the clinical pharmacology of thiazide diuretics, evidence for effectiveness in treating hypertension, as well as the side effects and controversies surrounding their use.
References
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2. Psaty BM, Lumley T, Furberg CD, Schellenbaum G, Pahor M, Alderman MH, Weiss NS.Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis. JAMA. 2003; 289 (19): 2534-44.
3. Feldman RD for the Canadian Hypertension Education Program. What’s new in the 2003 hypertension guidelines. Perspectives in Cardiology. 2003;19:44-51
4. Campbell NRC, McAlister F, Brant R, Levine M, Drouin D, Feldman R, Herman R, Zarnke K for the Canadian Hypertension Education Process and Evaluation Committee. Temporal trends in antihypertensive drug prescriptions in Canada before and after introduction of the Canadian Hypertension Education Program. J Hypertens. (In Press).
5. Shah S, Khatri I, Freis ED. Mechanism of action of thiazides diuretics. Am Heart Journal 1978; 95:611-8
6. Pickkers P, Hughes AD, Russel FGM, Thien T, Smits P. Thiazide-induced vasodilation in humans is mediated by potassium channel activation. Hypertension 1998; 32:1071-6.
7. Shah S, Khatri I, Freis ED. Mechanism of action of thiazides diuretics. Am Heart Journal 1978; 95:611-8
8. Cushman WC, Khatri I, Materson BJ, Reda DJ, Freis ED, Goldstein G et al. Treatment of hypertension in the elderly. III response of isolated systolic hypertension to various doses of hydorchlorothiazide: Results of a Department of Veteran Affairs cooperative study. Arch Intern Med 1991; 151:1954-1960
9. Kaplan NM. The case of low dose diuretic therapy. Am J Hypertens 1991; 4:970-1
10. Frishman WH, Bryzinski BS, Coulson LR et al. A multifactorial trial design to assess combination therapy in hypertension: treatment with bisoprolol and hydrochlorothiazide. Arch Intern Med 1994; 154:1461-1468
11. Peters, DC, Noble S, Plosker GL. Trandolapril. An update of its pharmacology and therapeutic use in cardiovascular disorders. Drugs 1998; 56:871-888
12. Progress Collaborative Group. Randomized trial of a perindopril-based blood pressurelowering regime among 6105 individuals with previous stroke or transient ischaemic attack. The Lancet 2001; 358:1033-1041.
13. Frishman WH, Bryzinski BS, Coulson LR et al. A multifactorial trial design to assess combination therapy in hypertension: treatment with bisoprolol and hydrochlorothiazide. Arch Intern Med 1994; 154:1461-1468
14. Psaty BM, Smith NL, Siscovick DS, Koepsell TD, Weiss NS, Heckbert SR, Lemaitre RN, Wagner EH, Furberg CD. Health outcomes associated with antihypertensive therapies used as first-line agents. A systematic review and meta-analysis. JAMA. 1997; 277(9): 739- 45.
15. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensinconverting enzyme inhibitor or calcium channel blocker vs. diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002; 288 (23): 2981-97
16. Moser M. Why are physicians not prescribing diuretics more frequently in the management of hypertension? JAMA. 1998; 279(22): 1813- 6.
17. Neaton JD, Grimm RH, Jr., Prineas RJ, et al. Treatment of mild hypertension study. Final results. JAMA. 1993; 270:713-24
18. Cushman WC, Khatri I, Materson BJ, Reda DJ, Freis ED, Goldstein G et al. Treatment of hypertension in the elderly. III response of isolated systolic hypertension to various doses of hydorchlorothiazide: Results of a Department of Veteran Affairs cooperative study. Arch Intern Med 1991; 151: 1954- 1960
19. Law MR, Wald NJ, Morris JK, Jordan RE. Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomized trials. BMJ 2003; 326: 1427-0.
2. Psaty BM, Lumley T, Furberg CD, Schellenbaum G, Pahor M, Alderman MH, Weiss NS.Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis. JAMA. 2003; 289 (19): 2534-44.
3. Feldman RD for the Canadian Hypertension Education Program. What’s new in the 2003 hypertension guidelines. Perspectives in Cardiology. 2003;19:44-51
4. Campbell NRC, McAlister F, Brant R, Levine M, Drouin D, Feldman R, Herman R, Zarnke K for the Canadian Hypertension Education Process and Evaluation Committee. Temporal trends in antihypertensive drug prescriptions in Canada before and after introduction of the Canadian Hypertension Education Program. J Hypertens. (In Press).
5. Shah S, Khatri I, Freis ED. Mechanism of action of thiazides diuretics. Am Heart Journal 1978; 95:611-8
6. Pickkers P, Hughes AD, Russel FGM, Thien T, Smits P. Thiazide-induced vasodilation in humans is mediated by potassium channel activation. Hypertension 1998; 32:1071-6.
7. Shah S, Khatri I, Freis ED. Mechanism of action of thiazides diuretics. Am Heart Journal 1978; 95:611-8
8. Cushman WC, Khatri I, Materson BJ, Reda DJ, Freis ED, Goldstein G et al. Treatment of hypertension in the elderly. III response of isolated systolic hypertension to various doses of hydorchlorothiazide: Results of a Department of Veteran Affairs cooperative study. Arch Intern Med 1991; 151:1954-1960
9. Kaplan NM. The case of low dose diuretic therapy. Am J Hypertens 1991; 4:970-1
10. Frishman WH, Bryzinski BS, Coulson LR et al. A multifactorial trial design to assess combination therapy in hypertension: treatment with bisoprolol and hydrochlorothiazide. Arch Intern Med 1994; 154:1461-1468
11. Peters, DC, Noble S, Plosker GL. Trandolapril. An update of its pharmacology and therapeutic use in cardiovascular disorders. Drugs 1998; 56:871-888
12. Progress Collaborative Group. Randomized trial of a perindopril-based blood pressurelowering regime among 6105 individuals with previous stroke or transient ischaemic attack. The Lancet 2001; 358:1033-1041.
13. Frishman WH, Bryzinski BS, Coulson LR et al. A multifactorial trial design to assess combination therapy in hypertension: treatment with bisoprolol and hydrochlorothiazide. Arch Intern Med 1994; 154:1461-1468
14. Psaty BM, Smith NL, Siscovick DS, Koepsell TD, Weiss NS, Heckbert SR, Lemaitre RN, Wagner EH, Furberg CD. Health outcomes associated with antihypertensive therapies used as first-line agents. A systematic review and meta-analysis. JAMA. 1997; 277(9): 739- 45.
15. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensinconverting enzyme inhibitor or calcium channel blocker vs. diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002; 288 (23): 2981-97
16. Moser M. Why are physicians not prescribing diuretics more frequently in the management of hypertension? JAMA. 1998; 279(22): 1813- 6.
17. Neaton JD, Grimm RH, Jr., Prineas RJ, et al. Treatment of mild hypertension study. Final results. JAMA. 1993; 270:713-24
18. Cushman WC, Khatri I, Materson BJ, Reda DJ, Freis ED, Goldstein G et al. Treatment of hypertension in the elderly. III response of isolated systolic hypertension to various doses of hydorchlorothiazide: Results of a Department of Veteran Affairs cooperative study. Arch Intern Med 1991; 151: 1954- 1960
19. Law MR, Wald NJ, Morris JK, Jordan RE. Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomized trials. BMJ 2003; 326: 1427-0.