Document Detail

Diuretics: still essential drugs for the management of hypertension.
MedLine Citation:
PMID:  19505274     Owner:  NLM     Status:  MEDLINE    
According to most current international guidelines for hypertension, diuretics are indicated for elderly and black patients, unless they have any of a long list of other preferential indications. These recommendations are mostly based on the results of corporate-sponsored and biased trials, which have unsuccessfully tried to demonstrate the existence of pleiotropic effects of newer agents. Metaregression analyses have shown that the benefits of treatments are directly proportional to the difference in blood pressure between trial arms. New analyses of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack (ALLHAT) trial demonstrated the superiority of chlorthalidone over other agents in the prevention of end-stage renal disease in diabetics and of cardiovascular events in newer cases of diabetes. Despite this evidence, patients continue to withdraw from effective therapies in recent trials. The use of diuretics has also been challenged by the results of the Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial, which employed hydrochlorothiazide, a diuretic with lower potency and duration of action than chlorthalidone. Diuretics are still essential drugs for hypertension management, but diuretics with higher potency and duration of action, such as chlorthalidone, should be preferred.
Flávio Danni Fuchs
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Expert review of cardiovascular therapy     Volume:  7     ISSN:  1744-8344     ISO Abbreviation:  Expert Rev Cardiovasc Ther     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-09     Completed Date:  2009-08-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101182328     Medline TA:  Expert Rev Cardiovasc Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  591-8     Citation Subset:  IM    
Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, 90.035-903, Porto Alegre, RS, Brazil.
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MeSH Terms
African Continental Ancestry Group
Antihypertensive Agents / therapeutic use
Blood Pressure / drug effects*
Clinical Trials as Topic / standards
Diuretics / therapeutic use*
Drug Therapy, Combination
Hypertension / drug therapy*,  physiopathology
Practice Guidelines as Topic
Regression Analysis
Reg. No./Substance:
0/Antihypertensive Agents; 0/Diuretics

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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