Which thiazide to choose as add-on therapy for hypertension?

摘要: Combined therapy is required in the majority of patients with hypertension to achieve blood pressure (BP) targets. Although different antihypertensive drugs can be combined, not all combinations are equally effective and safe. In this context, combination a renin angiotensin system inhibitor diuretic, usually thiazide, particularly hydrochlorothiazide (HCTZ) or thiazide-like diuretics, such as chlorthalidone indapamide, recommended. However, diuretics equal. HCTZ, chlorthalidone, indapamide add-on effectively reduce BP levels, studies have obtained greater reductions than HCTZ. Moreover, there data showing benefits beyond BP. Thus, seems pleiotropic effects reduction. compared placebo, has small on fasting glucose total cholesterol, achieves significantly lower cholesterol low-density lipoprotein levels. Similarly, demonstrated no negative impact lipid metabolism. More importantly, although head-to-head clinical trials comparing HCTZ available, indirect comparisons post hoc analyses suggest that use associated reduction cardiovascular events. Despite this, most frequent diuretic used practice for The purpose review update published efficacy safety hypertension.