Diuretics in antihypertensive treatment - new facts, old concerns. Is it time for a right choice?

Abstract

Diuretics are well-established antihypertensive agents. The recent American hypertension guidelines (JNC 7) ascribe a singular place to diuretics in first-line treatment of uncomplicated hypertension following a one-sided interpretation of the ALLHAT results. In contrast, in the guidelines of the European Society of Hypertension published in 2003, diuretics are placed alongside beta-blockers, angiotensin converting enzyme inhibitors, sartans, and calcium antagonists as the drugs of the first choice, but not preference. Detailed analysis of ALLHAT, as well as ASCOT study did not confirmed superiority of diuretics over other classes of antihypertensive agents. ASCOT study has even showed the superiority of new groups of antihypertensive drugs over conventional therapy in the risk reduction of serious cardiovascular complications of hypertension. The aim of the study is to answer the question, if the actually increasing position of diuretics in antihypertensive therapy is scientifically and clinically justifiable, and if their less expressive organoprotective actions and their numerous adverse effects are strong enough arguments against the therapeutic universality of this group of drugs.