Reevaluating chlorthalidone as thiazide ‘diuretic of choice’

Maria G. Tanzi

doi:10.1016/j.ptdy.2020.04.009

Thiazides in pregnancy

Drug and Therapeutics Bulletin ◽

10.1136/dtb.3.3.10 ◽

1965 ◽

Vol 3 (3) ◽

pp. 10-11

Keyword(s):

Blood Pressure ◽

Perinatal Mortality ◽

Thiazide Diuretic ◽

Late Pregnancy ◽

Common Complication ◽

In Pregnancy

Pre-eclampsia is a common complication of late pregnancy and may endanger the life of the mother or her child. The cause is unknown and treatment is aimed at correcting the manifestations of the disease empirically. The signs are hypertension, oedema and proteinuria, and one of these, the oedema, can often be reduced by a thiazide diuretic. In some studies1–3 but not in others4–6 thiazides have also been reported to lower the blood pressure. Proteinuria persists and may worsen7 and the perinatal mortality is not improved8 with thiazide therapy. The placental damage associated with pre-eclampsia and its effects on the foetus are apparently not reversed when the oedema and hypertension are reduced.

Download Full-text

Diuretics in hypertension

Drug and Therapeutics Bulletin ◽

10.1136/dtb.13.26.101 ◽

1975 ◽

Vol 13 (26) ◽

pp. 101-103

Keyword(s):

Essential Hypertension ◽

Plasma Renin Activity ◽

Thiazide Diuretic ◽

Mild Hypertension ◽

Antihypertensive Drugs ◽

Antihypertensive Agents ◽

Plasma Renin ◽

Renin Activity ◽

Thiazide Diuretics ◽

Treatment Of Hypertension

Thiazide diuretics such as bendrofluazide and chlorothiazide have been used for nearly 20 years in the treatment of hypertension. They have been regarded as rather weak antihypertensive agents which could be used alone only in mild hypertension and otherwise as adjuvants to more potent drugs in more serious cases.1 There are however some patients with ‘essential’ hypertension who are very sensitive to diuretics and in whom the pressure may be brought down to normal by a thiazide2 or spironolactone3 even when it is initially considerably raised. Furthermore a few patients who are responsive to thiazides are strikingly unresponsive to non-diuretic antihypertensive drugs. Patients particularly likely to respond to a thiazide diuretic4 or spironolactone3 commonly have low plasma renin activity and this occurs in about 25% of patients with essential hypertension.5 Since plasma renin activity is not routinely estimated it is simplest to identify these patients by observing the response to an adequate trial of a thiazide.

Download Full-text

Three new antihypertensive drugs: esbatal, envacar and vatensol

Drug and Therapeutics Bulletin ◽

10.1136/dtb.2.11.41 ◽

1964 ◽

Vol 2 (11) ◽

pp. 41-42

Keyword(s):

Blood Pressure ◽

Blood Loss ◽

Thiazide Diuretic ◽

Antihypertensive Drugs ◽

Standing Position ◽

Adrenergic Blockade ◽

Concurrent Administration ◽

Hot Environment ◽

Nasal Stuffiness

These chemically related drugs lower the blood pressure by blocking adrenergic neurones, and their effects resemble those of guanethidine and bretylium. Concurrent administration of a thiazide diuretic potentiates each of these drugs, thus allowing the dose to be reduced. As might be expected the greatest reduction in blood pressure normally occurs in the standing position, but symptoms of hypotension, such as faintness, giddiness and weakness occur if the dose is excessive or under conditions which potentiate the effect of adrenergic blockade, for example, on first rising from bed, in a hot environment, during and after exercise, and after blood loss. Other symptoms caused by adrenergic blockade, such as nasal stuffiness and failure of ejaculation are common. Impotence has been reported.

Download Full-text