Fifty Years of Thiazide Diuretic Therapy for Hypertension

BACKGROUND: The use of thiazide diuretics has decreased over the past 30 years despite data from many well-controlled clinical trials demonstrating that the use of these agents as monotherapy or in combination with other antihypertensive agents will reduce blood pressure and decrease cardiovascular as well as cerebrovascular events. METHODS: We reviewed clinical and experimental data on thiazide diuretics since their introduction in the late 1950s. RESULTS: The results of thiazide-based therapy in young and old are consistently positive despite concerns about some metabolic changes, eg, insulin resistance or hypokalemia, that may occur. CONCLUSION: We conclude that these agents are safe, effective, and well tolerated and should continue to be used either as monotherapy or with other medications in the management of hypertension.