Place des diuretiques dans le traitement de l'hypertension: Des grands essais controles aux recommandations internationales

Translated title of the contribution: Place of diuretics in the treatment of hypertension from large controlled trials to international recommendations

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Abstract

Diuretics were used in most of the major trials that demonstrated that lowering the blood pressure reduced cardiovascular morbidity and mortality. Nevertheless in the second half of the eighties, there were misgivings about the widespread use of thiazide diuretics, driven in part by the relative failure of the large trials to reduce myocardial infarction to the extent predicted by large scale epidemiological studies. There was much attention on metabolic side effect of thiazide diuretics including dyslipidaemia, glucose intolerance, hypokalaemia, hyperuricaemia, and then microalbuminuria particularly in diabetic subjects. These issues were current when JNC(IV) (1988) and the WHO-ISH guidelines (1989) were being written. Three major clinical trials SHEP, STOP and MRC published in the early nineties established that thiazide diuretics alone, or in combination with beta blockers, did reduce cardiovascular morbidity and mortality in elderly subjects with hypertension. All guidelines published since 1993 include diuretics among the first line drugs. Possibly the most important factor in the restoration of diuretics has been the use of progressively lower doses that minimise the metabolic side effects. Diuretics are effective as monotherapy in the treatment of mild essential hypertension and of isolated systolic hypertension in elderly subjects. They are very useful in combination with beta blockers or with ACE inhibitors. They should be avoided in patients with gout and should not be used as first line drugs in patients with diabetes. They should only be used with caution in young obese subjects with dyslipidaemia and increased risk of coronary artery disease, facing many decades of treatment for hypertension. However there is no doubt that diuretics are effective, cheap and have a central role in the control of hypertension in all communities around the world.

Translated title of the contributionPlace of diuretics in the treatment of hypertension from large controlled trials to international recommendations
Original languageFrench
Pages (from-to)39-43
Number of pages5
JournalArchives des Maladies du Coeur et des Vaisseaux
Volume89
Issue numberSPEC. ISS. 4
Publication statusPublished - 1996
Externally publishedYes

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