2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Morganti, A. Search for Related Content PubMed PubMed Citation Articles by Morganti, A.

Should a Diuretic Always Be the First Choice in Patients with Essential Hypertension? The Case for No

Cattedra di Medicina Interna and Centro Ipertensione Arteriosa, Ospedale S. Paolo and Centro Fisiologia Clinica e Ipertensione, IRCCS Ospedale Maggiore, University of Milan, Milan, Italy

Address correspondence to: Prof. Alberto Morganti, Centro di Fisiologia Clinica e Ipertensione Ospedale Maggiore Via F. Sforza, 35-20122 Milano, Italy. Phone: +39-02-5503-3506; Fax: +39-02-503-20480; E-mail: alberto.morganti{at}unimi.it

A more extensive use of diuretics as first-line drug for the treatment of hypertensive patients has been recommended on the basis of the results of the recent Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial, yet diuretics have numerous drawbacks that may limit their undisputed ability to lower BP. These include the stimulation of the renin-angiotensin-aldosterone system with the attending negative cardiovascular effects that ensue from this activation and several metabolic alterations, namely those in glucose, lipid, and potassium metabolism. Numerous mechanistic as well as interventional trials indicate that these limitations of diuretics can adversely affect the clinical outcome of patients and their compliance to treatment and consequently the cost of therapy. In addition, there are a number of clinical conditions in which the diuretics are admittedly contraindicated as first-line drugs. Thus, the emphasis should be on obtaining optimal BP control rather on the drug used to achieve it.

This article has been cited by other articles:

				P. Gross and C. Palm Thiazides: do they kill? Nephrol. Dial. Transplant., November 1, 2005; 20(11): 2299 - 2301. [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673