, Volume 59, Supplement 2, pp 21–25 | Cite as

Diuretics as a Basis of Antihypertensive Therapy

An Overview
  • Norman M. Kaplan
Review Article


Diuretics have been, except for during a few recent years, the most commonly used therapy for hypertension. Although use of these agents fell significantly in the early 1990s, since then it has begun to increase again. Their recent return to popularity reflects 3 major factors: (i) recognition of the effectiveness of much lower dosages than previously used, thereby providing good antihypertensive activity with fewer adverse effects; (ii) the excellent reductions in morbidity and mortality achieved by low dosage diuretic-based therapy in multiple randomised controlled trials in elderly patients with hypertension; and (iii) the increasing recognition that some diuretic-induced shrinkage of effective blood volume is essential for the adequate treatment of many, if not most, patients with hypertension. Therefore, diuretics will probably continue to be the basis for antihypertensive therapy, and the indapamide sustained release 1.5mg formulation provides all the essential characteristics of diuretic therapy.


  1. 1.
    Neaton JD, Grimm Jr RH, Prineas RJ, et al. Treatment of mild hypertension study (TOMHS): final results. JAMA 1993; 270: 713–24PubMedCrossRefGoogle Scholar
  2. 2.
    Materson BJ, Reda DJ, Cushman WC. Department of Veterans Affairs single-drug therapy of hypertension study. Revised figures and new data. Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. Am J Hypertens 1995; 8: 189–92Google Scholar
  3. 3.
    Frishman WH, Bryzinski BS, Coulson LR, et al. A multifactorial trial design to assess combination therapy in hypertension. Arch Intern Med 1994; 154: 1461–8PubMedCrossRefGoogle Scholar
  4. 4.
    Townsend RR, Holland OB. Combination of converting enzyme inhibitor with diuretic for the treatment of hypertension. Arch Intern Med 1990; 150: 1174–83CrossRefGoogle Scholar
  5. 5.
    Meyrier A, Dratwa M, Sennesael J, et al. Fixed low-dose perindopril-indapamide combination with hypertensive patients with chronic renal failure. Am J Hypertens 1998; 11: 1087–92PubMedCrossRefGoogle Scholar
  6. 6.
    Flack JM. Evidence for the efficacy of low-dose diuretic monotherapy. Am J Med 1996; 101(3A): 53S–60PubMedCrossRefGoogle Scholar
  7. 7.
    Ambrosioni E, Safar M, Degaute J-P, et al. Low-dose antihypertensive therapy with 1.5 mg sustained-release indapamide: results of randomised double-blind controlled studies. Am J Nephrol 1995; 15: 251–5CrossRefGoogle Scholar
  8. 8.
    SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA 1991; 266: 3255–64CrossRefGoogle Scholar
  9. 9.
    Dahlof B, Lindholm LH, Hansson L, et al. Morbidity and mortality in the Swedish Trial in old patients with hypertension (STOP-Hypertension). Lancet 338: 1281–5Google Scholar
  10. 10.
    Medical Research Council trial of treatment of hypertension in older adults: principal results. MRC Working Party. BMJ 1992; 304: 405–12CrossRefGoogle Scholar
  11. 11.
    Curb JD, Pressel SL, Cutler JA, et al. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. JAMA 1996; 9: 828–32Google Scholar
  12. 12.
    Siscovick DS, Raghunathan TE, Psaty BM, et al. Diuretic therapy for hypertension and the risk of primary cardiac arrest. N Engl J Med 1994; 330: 1852–7PubMedCrossRefGoogle Scholar
  13. 13.
    Psaty BM, Smith NL, Siscovick DS, et al. Health outcomes associated with antihypertensive therapies used as first-line agents. JAMA 1997; 277: 739–45PubMedCrossRefGoogle Scholar
  14. 14.
    Madkour H, Gadallah M, Riveline B, et al. Comparison between the effects of indapamide and hydrochlorothiazide on creatinine clearance in patients with impaired renal function and hypertension. Am J Nephrol 1995; 15: 251–5PubMedCrossRefGoogle Scholar
  15. 15.
    Lacourcière Y, Provencher P. Comparative effects of zofenopril and hydrochlorothiazide on office and ambulatory blood pressures in mild to moderate essential hypertension. Br J Clin Pharmacol 1989; 27: 371–6PubMedCrossRefGoogle Scholar
  16. 16.
    Omvik P, Tarazi ED, Bravo EL. Regulation of sodium balance in hypertension. Hypertension 1980; 2: 515–23PubMedCrossRefGoogle Scholar
  17. 17.
    Finnerty Jr FA, Davidov M, Mroczek WJ, et al. Influence of extracellular fluid volume on response to antihypertensive drugs. Circ Res 1970; 26 Suppl. 1: 71–80CrossRefGoogle Scholar
  18. 18.
    Manning G, Miller-Craig MW. Review: calcium antagonists and diuretics; a useful combination in the management of hypertension? J Hum Hypertens 1996; 10: 441–2PubMedGoogle Scholar
  19. 19.
    Woodwell DA. National ambulatory medical care survey: 1996 summary. In: Advance data from vital and health statistics. No. 295. Hyattsville, MD: National Center for Health Statistics, 1997Google Scholar
  20. 20.
    Anderson J, Godfrey BE, Hill DM, et al. A comparison of the effects of hydrochlorothiazide and of furosemide in the treatment of hypertensive patients. Q J Med 1971; 40: 541–60PubMedGoogle Scholar
  21. 21.
    Wilcox CS, Mitch WE, Kelly RA, et al. Response of the kidney to furosemide I: effects of salt intake and renal compensation. J Lab Clin Med 1983; 102(3): 450–8PubMedGoogle Scholar
  22. 22.
    Yakovlevitch M, Black HR. Resistant hypertension in a tertiary care clinic. Arch Intern Med 1991; 151: 1786–92PubMedCrossRefGoogle Scholar
  23. 23.
    Paton RR, Kane RE. Long-term diuretic therapy with metolazone of renal failure and the nephrotic syndrome. J Clin Pharm 1977; 17: 243–51CrossRefGoogle Scholar
  24. 24.
    Dunn CJ, Fitton A, Brogden RN. Torasemide. An update of its pharmacological properties and therapeutic efficacy. Drugs 1995; 49: 121–42Google Scholar
  25. 25.
    Joint National Committee. The Sixth Report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (JNC VI). Arch Intern Med 1997; 158: 2413–46Google Scholar
  26. 26.
    Guidelines Subcommitte. 1999 World Health Organization-International Society of Hypertension guidelines for the management of hypertension. J Hypertens 1999; 17: 151–83Google Scholar
  27. 27.
    Leonetti G. Clinical positioning of indapamide sustained release 1.5mg in management protocols for hypertension. Drugs 2000; 59 Suppl. 2: 27–38PubMedCrossRefGoogle Scholar
  28. 28.
    Walma EP, Hoes AW, van Dooren C, et al. Withdrawal of long term diuretic medication in elderly patients: a double blind randomised trial. BMJ 1997; 315: 464–8PubMedCrossRefGoogle Scholar
  29. 29.
    Grimm Jr RH, Grandits GA, Prineas RJ, et al. Long term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment of hypertensive men and women. Treatment of Mild Hypertension Study (TOMHS). Hypertension 1997; 29: 8–14PubMedGoogle Scholar
  30. 30.
    Leonetti G, Rappelli A, Salvetti A, et al. Tolerability and well-being with indapamide in the treatment of mild-moderate hypertension. An Italian multicenter study. Am J Med 1988; 84(1B): 59–64PubMedGoogle Scholar

Copyright information

© Adis International Limited 2000

Authors and Affiliations

  • Norman M. Kaplan
    • 1
  1. 1.Southwestern Medical CenterThe University of TexasDallasUSA

Personalised recommendations