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  • Title: Thiazide diuretics: first-line therapy for hypertension.
    Author: Ramsay LE, Yeo WW, Jackson PR.
    Journal: J Hypertens Suppl; 1992 Jun; 10(3):S29-32; discussion S32-3. PubMed ID: 1353112.
    Abstract:
    PURPOSE: To compare low-dose thiazides to beta-blockers, angiotensin converting enzyme (ACE) inhibitors, calcium antagonists and alpha-blockers for simplicity, tolerability, efficacy, safety and cost-effectiveness as first-line treatment for hypertension. METHOD: Review of short-term comparative studies, and the outcome of long-term trials with vascular complications of hypertension as endpoints. SIMPLICITY: Among the advantages of thiazides are a flat dose-response; no dose titration; effectiveness when used once a day; no first-dose hypotension; and few contra-indications. TOLERABILITY: Thiazides are the best tolerated agents in patients over the age of 60 years and in younger women. They sometimes cause gout and impotence in younger men, in whom beta-blockers are equally acceptable first-line therapy. EFFICACY: Thiazide-based regimens have consistently reduced vascular complications of hypertension, the real measure of efficacy. There is little evidence that regimens based on other drugs are effective in this sense. SAFETY: Concerns that thiazide-induced biochemical changes cause coronary events are baseless. An overview of outcome trials shows that thiazide-based treatment reduces coronary events significantly, and the reduction is not significantly different from that predicted by epidemiological data. Thiazide-based therapy has also reduced coronary events significantly and substantially in elderly patients with isolated systolic hypertension. COST-EFFECTIVENESS: Low-dose thiazide treatment needs minimal monitoring, and has proved most cost-effective in formal analyses. CONCLUSION: Low-dose thiazide treatment is a clear first-line choice for patients aged over 60 years and younger women, except those with diabetes or gout. In younger men there is little to choose between thiazides and beta-blockers.
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