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Diuretics in the treatment of hypertension

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Abstract

Diuretics have long been used for the treatment of hypertension. Thiazide diuretics are the most commonly prescribed diuretics for hypertension, but other classes of diuretics may be useful in alternative circumstances. Although diuretics are no longer considered the preferred agent for treatment of hypertension in adults and children, they remain acceptable first-line options. Diuretics effectively decrease blood pressure in hypertensive patients, and in adults with hypertension reduce the risk of adverse cardiovascular outcomes. Because of varied pharmacokinetic and pharmacodynamic differences, chlorthalidone may be the preferred thiazide diuretic in the treatment of primary hypertension. Other types of diuretics (e.g., loop, potassium sparing) may be useful for the treatment of hypertension related to chronic kidney disease (CKD) and other varied conditions. Common side effects of thiazides are mostly dose-related and involve electrolyte and metabolic abnormalities.

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Author information

Authors and Affiliations

  1. Pediatrics and Pharmacology, Division of Pediatric Nephrology, Children’s Mercy Hospital, University of Missouri, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Douglas L. Blowey

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  1. Douglas L. Blowey
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Corresponding author

Correspondence to Douglas L. Blowey.

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The author declares that he has no conflict of interest.

Additional information

Answers to questions

1: e

2: a

3: b

4: b

5: d

Appendices

Key summary points

  1. 1.

    Thiazide diuretics are effective antihypertensive agents that can be considered as first-line therapy for adults and children with hypertension.

  2. 2.

    Chlorthalidone possesses unique pharmacokinetic and pharmacodynamics properties and should be considered the preferred thiazide diuretic for the treatment of hypertension.

  3. 3.

    Although there is a lack of outcome data in children, in adults with hypertension treatment with a thiazide diuretic decreases the morbidity and mortality associated with hypertension.

  4. 4.

    The long-term blood pressure-lowering effect of thiazide diuretics is mediated by vasodilation.

  5. 5.

    Electrolyte abnormalities are the most common adverse effects associated with the use of thiazide diuretics for hypertension and serial assessment of serum electrolytes and magnesium are warranted with chronic therapy.

Multiple-choice questions (answers are provided following the reference list)

  1. 1.

    In children and adults with hypertension, which of the following antihypertensive agents are considered appropriate for first-line pharmacologic therapy?

    1. a)

      ACE inhibitors

    2. b)

      ARBs

    3. c)

      Calcium channel blockers

    4. d)

      Thiazide diuretics

    5. e)

      All of the above

  2. 2.

    Which of the following thiazide diuretics is associated with a greater improvement in the 24-h blood pressure profile?

    1. a)

      Chlorthalidone

    2. b)

      Hydrochlorothiazide

    3. c)

      Chlorothiazide

    4. d)

      Metolazone

  3. 3.

    Loop diuretics (e.g., furosemide) may be useful when hypertension is associated with which of the following conditions?

    1. a)

      Essential hypertension

    2. b)

      Chronic kidney disease

    3. c)

      ENaC mutations

    4. d)

      Anuric patients on chronic hemodialysis

  4. 4.

    A documented allergy to sulfa-based antibiotics is a contraindication to the use of thiazide diuretics?

    1. a)

      True

    2. b)

      False

  5. 5.

    Which of the following is the proposed mechanism for the blood pressure-lowering effect associated with chronic thiazide therapy?

    1. a)

      A decrease in the ECF volume

    2. b)

      Decreased cardiac output

    3. c)

      A reduction in the RAAS activity

    4. d)

      Vasodilation

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Blowey, D.L. Diuretics in the treatment of hypertension. Pediatr Nephrol 31, 2223–2233 (2016). https://doi.org/10.1007/s00467-016-3334-4

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