Diuretics in the Treatment of Hypertension: are They So Bad and are All of Them Equal? Part 2

H.D. Radchenko


This paper is the second part of literature review on the application of diuretics in the treatment of arterial hypertension. There were evaluated the adverse effects of diuretics and possibilities of their prevention and correction. A comparison of the effectiveness of different diuretics in preventing cardiovascular events has been performed. Attention is drawn to the rules of selection and correction of diuretic therapy based on the patient’s characteristics.


arterial hypertension; diuretics; adverse effects; differences between diuretics; rules of selection


Grimm R.H. Jr, Grandits G.A., Cutler J.A et al. Relationships of quality-of-life measures to long-term lifestyle and drugtreatment in the Treatment of Mild Hypertension Study // Arch. Intern. Med. — 1997. — Vol. 15. — P. 638-648.

Cushman W.C., Khatri I., Materson B.J. et al. Treatment of hypertension in the elderly. III. Response of isolated systolic hypertension to various doses of hydrochlorothiazide: results of a Department of Veterans Affairs cooperative study // Arch. Intern. Med. — 1991. — Vol. 151. — P. 1954-60.

Carter B.L., Einhorn P.T., Brands M. et al. Thiazide-induced dysglycemia: call for research from a working group from the National Heart, Lung, and Blood Institute // Hypertension. — 2008. — Vol. 52. — P. 30-36.

Franse L.V., Pahor M., Di Bari M., Somes G.W., Cushman W.C., Applegate W.B. Hypokalemia associated with diuretic use and cardiovascular events in the Systolic Hypertension in the Elderly Program // Hypertension. — 2000. — Vol. 35. — P. 1025-1030.

Ram C.V., Garrett B.N., Kaplan N.M. Moderate sodium restriction and various diuretics in the treatment of hypertension // Arch. Intern. Med. — 1981. — Vol. 141. — Р. 1015-1019.

Turnbull F., Neal B., Algert C. et al. Effects of different blood pressure-lowering regimens on major cardiovascular events in individuals with and without diabetes mellitus: results of prospectively designed overviews of randomized trials // Arch. Intern. Med. — 2005. — Vol. 165. — P. 1410-1419.

Curb J.D., Pressel S.L., Cutler J.A. et al. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension // JAMA. — 1996. — Vol. 276. — P. 1886-1892.

Kostis J.B., Wilson A.C., Freudenberger R.S., Cosgrove N.M., Pressel S.L., Davis B.R. Long-term effect of diuretic-based therapy on fatal outcomes in subjects with isolated systolic hypertension with and without diabetes // Am. J. Cardiol. — 2005. — Vol. 95. — P. 29-35.

Samuelsson O., Pennert K., Andersson O., Berglund G., Hedner T., Persson B., Wedel H., Wilhelmsen L. Diabetes mellitus and raised serum triglyceride concentration in treated hypertension — are they of prognostic significance? // Brit. Med. J. — 1996. — Vol. 313. — P. 660-663.

Verdecchia P., Reboldi G., Angeli F., Borgioni C., Gattobigio R., Filippucci L., Norgiolini S., Bracco C., Porcellati C. Adverse prognostic significance of new diabetes in treated hypertensive subjects // Hypertension. — 2004. — Vol. 43. — P. 963-969.

Zillich A.J., Garg J., Basu S., Bakris G.L., Carter B.L. Thiazide diuretics, potassium, and the development of diabetes: a quantitative review // Hypertension. — 2006. — Vol. 48. — P. 219-224.

Shafi T., Appel L.J., Miller E.R. III, Klag M.J., Parekh R.S. Changes in serum potassium mediate thiazide-induced diabetes // Hypertension. — 2008. — Vol. 52. — P. 1022-1029.

Jamerson K., Weber M.A., Bakris G.L. et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in highrisk patients // N. Engl. J. Med. — 2008. — Vol. 359. — P. 2417-2428.

Gress T.W., Nieto F.J., Shahar E., Wofford M.R., Brancati F.L. Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus: Atherosclerosis Risk in Communities Study // N. Engl. J. Med. — 2000. — Vol. 342. — P. 905-912.

Savage P.J., Pressel S.L., Curb J.D. et al. Influence of long-term, low-dose, diuret-ic-based, antihypertensive therapy on glucose, lipid, uric acid, and potassium levels in older men and women with isolated systolic hypertension: the Systolic Hyper-tension in the Elderly Program // Arch. Intern. Med. — 1998. — Vol. 158. — P. 741-751.

Carter B.L., Ernst M.E., Cohen J.D. Hydrochlorothiazide versus chlorthalidone: evidence supporting their interchangeability // Hypertension. — 2004. — Vol. 43. — P. 4-9.

Elliott W.J., Grimm R.H. Jr. Using diuretics in practice — one opinion // J. Clin. Hypertens. (Greenwich.) — 2008. — Vol. 10. — P. 856-862.

Management of hypertension: summary of NICE guidance // BMJ. — 2011. — Vol. 343. — P. 4891.

Wing L.M.H., Reid C.M., Ryan P. et al. A comparison of outcomes with angitensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly // N. Engl. J. Med. — 2003. — Vol. 348. — P. 583-589.

Jackson E.K. Diuretics / Brunton L.L., Lazo J.S., Par­ker K.L. // Goodman & Gilman’s the pharmacological basis of thera-peutics. 11th ed. — New York: McGraw-Hill, 2006. — P. 737-770.

Bowlus W.E., Langford H.G. A comparison of the antihypertensive effect of chlorthalidone and hydrochlorothiazide // Clin. Pharmacol. Ther. — 1964. — Vol. 5. — P. 708-711.

Finnerty F.A. Jr. A double-blind study of chlorthalidone and hydrochlorothiazide in an outpatient population of moderate hypertensives // Angiology. — 1976. — Vol. 27. — P. 738-744.

Ernst M.E., Carter B.L., Goerdt C.J. et al. Comparative antihypertensive effects of hydrochlorothiazide and chlorthalidone on ambulatory and office blood pressure // Hypertension. — 2006. — Vol. 47. — P. 352-358.

Grossman E., Sharabi Y., Messerli F.H. Thiazide-induced hyponatremia is predictable // Am. J. Med. — 2012. — Vol. 125(8). — Р. 9.

Engberink R., Frenkel W., van den Bogaard B. et al. Effects of Thiazide-Type and Thiazide-Like Diuretics on Cardiovascular Events and Mortality Systematic Review and Meta-Analysis // Hypertension. — 2015. — Vol. 65. — P. 1033-1040.

Siscovick D., Raghunathan T., Psaty B. et al. Diuretic Therapy for Hypertension and the Risk of Primary Cardiac Arrest // N. Engl. J. Med. — 1994. — Vol. 330. — P. 1852-1857.

Multiple Risk Factor Intervention Trial Research Group. Mortality After 101/2 Years for Hypertensive Participants in the Multiple Risk Factor Intervention Trial // Circulation. — 1990. — Vol. 82. — P. 1616-1628.

Dorsh M., Gillespie B., Erikson S. et al. Chlorthalidone reduces cardiovascular events compared with Hydrochlorthiazide: a retrospective cohort analysis // Hypertension. — 2011. — Vol. 57. — P. 689-694.

Madkour H., Gadallah M., Riveline B. et al. Indapamide is superior to thiazide in the preservation of renal function in patients with renal insufficiency and systemic hypertension // Am. J. Car­diol. — 1996. — Vol. 77. — P. 23-25B.

Leonetti G., Rappelli A., Salvetti A., Scapellato L. Long-term effects of indapamide: final re-sults of a two-year Italianmulticenter study in systemic hypertension // Am. J. Cardiol. — 1990. — Vol. 65. — P. 67H-71H.

Stears A.J., Woods S.H., Watts M.M. et al. A double-blind, placebo-controlled, crossover trial comparing the effects of amiloride and hydrochlorothiazide on glucose tolerance in patients with essential hypertension // Hypertens. — 2012. — Vol. 59. — P. 934-942.

Mancia G., Seravalle G., Grassi G. Tolerability and treatment compliance with angiotensin II receptor antagonists // Am. J. Hypertens. — 2003. — Vol. 16. — P. 1066-1073.

Kronish I., Woodward M., Sergie Z. et al. Meta-Analysis Impact of Drug Class on Adherence to Antihypertensives Circulation. — 2011. — Vol. 123. — P. 1611-1621.

Psaty B.M., Lumley T., Furberg C.D. Meta-analysis of health outcomes of chlorthalidone-based vs nonchlorthali-done-based low-dose diuretic therapie // JAMA. — 2004. — Vol. 292. — P. 43-44.

Dahlöf В., Devereux R., de-Faire U., Fyhrquist F., Hedner T., Ibsen H. et al. The Losartan Intervention for Endpoint reduction (LIFE) in Hypertension study: rationale, design, and methods // Am. J. Hypertens. — 1999. — Vol. 10. — P. 705-713.

Julius S., Kjeldsen S., Brunner H. et al. VALUE Trial: Long-Term Blood Pressure Trends in 13,449 Patients With Hypertension and High Cardiovascular Risk // Am. J. Hypertens. — 2003. — Vol. 16. — P. 544-548.

Knauf H., Mutschler E. Diuretic effectiveness of hydrochlorothiazide and furosemide alone and in combination in chronic renal failure // J. Cardiovasc. Pharmacol. — 1995. — Vol. 26. — P. 394-400.

Dussol B., Moussi-Frances J., Morange S., Somma-Delpero C., Mundler O., Berland Y. A randomized trial of furosemide vs hydrochlorothiazide in patients with chronic renal failure and hypertension // Nephrol. Dial. Transplant. — 2005. — Vol. 20. — P. 349-353.

Sica D.A., Moser M. Diuretic therapy in cardiovascular disease / Black H.R., Elliott W.J. // Hypertension: a companion to Braunwald’s heart disease. — Philadelphia: W.B. Saunders, 2007.

Paton R.R., Kane R.E. Long-term diuretic therapy with metolazone of renal failure and the nephrotic syndrome // J. Clin. Pharmacol. — 1977. — Vol. 17. — P. 243-251.

Ellison D.H. Diuretic resistance: physiology and therapeutics // Semin. Nephrol. — 1999.

Patel А., ADVANCE Collaborative Group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial // Lancet. — 2007. — Vol. 370. — P. 829-840.

Zoungas S., Chalmers J., Neal B. et al. Follow-up of Blood-Pressure Lowering and Glucose Control in Type 2 Diabetes // N. Engl. J. Med. — 2014. — Vol. 371. — P. 1392-1406.

Khan A.M. Effect of diuretics on the renal handling of urate // Semin. Nephrol. — 1998. — Vol. 8. — P. 305-314.

Janssens H.J.E.M., van de Lisdonk E.H., Janssens M., van den Hoogen H.J.M., Verbeek A.L.M. Gout, not induced by diure­tics? A case-control study from primary care // Ann. Rheum. Dis. — 2006. — Vol. 65(8). — P. 1080-1083.

Waller P.C., Ramsay L.E. Predicting acute gout in diuretic-treated hypertensive patients // J. Hum. Hypertens. — 1989. — Vol. 3(6). — P. 457-461.

Hopkinson N., Doherty M. In patients with chronic cardiac failure who have diuretic induced gout, are certain diuretics less prone at causing problems? // Br. J. Rheumatol. — 1991. — Vol. 30(3). — P. 225.

Coca A. Long-term blood pressure control and metabolic disorders induced by torasemide in hypertension // Amer. J. Hypertens. — 2001. — Vol. 14. — P. 116A.


Inaba M., Noguchi Y., Yamamoto T. et al. Effects of a low dose of indapamide, a diuretic, given daily or every-other-day on blood pressure and metabolic parameters // Hypertens. Res. — 2004. — Vol. 27. — P. 141-145.

DOI: https://doi.org/10.22141/2224-1485.2.46.2016.74493


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