Thiazide and the Thiazide-Like Diuretics: Review of Hydrochlorothiazide, Chlorthalidone, and Indapamide

Am J Hypertens. 2022 Apr 11:hpac048. doi: 10.1093/ajh/hpac048. Online ahead of print.ABSTRACTThe term thiazide is universally understood to refer to diuretics which exert their principal action in the distal tubule. The thiazide class is heterogenous, and can be further subdivided into compounds containing the benzothiadiazine ring structure - the thiazide-type (e.g. hydrochlorothiazide) - and those lacking the benzothiadiazine ring - the thiazide-like (e.g., chlorthalidone and indapamide) drugs. Thiazide-like agents are longer acting, and constitute the diuretics used in most of the cardiovascular outcome trials which established benefits of treatment with diuretics, but pragmatic aspects such as lack of availability in convenient formulations, limit their use. Regardless of class heterogeneity, thiazides have retained importance in the management of hypertension for over 60 years. They are reliably effective as monotherapy in a majority of hypertensive patients, and augment the efficacy of other classes of antihypertensives when used in combination. Importantly, a thiazide-based treatment regimen lowers cardiovascular events, and their sturdy effect reinforces their place among the recommended first-line agents to treat hypertension in major domestic and international hypertension guidelines. There are few head-to-head comparisons within the class, but potential differences have been explored indirectly as well as in non-blood pressure mechanisms and potential pleiotropic p...
Source: American Journal of Hypertension - Category: Cardiology Authors: Source Type: research