Old antihypertensive agents-diuretics and β-Blockers: Do we know how and in whom they lower blood pressure?

Abstract

Morbidity and mortality data that increasingly favor the use of diuretics and beta-blockers continue to accumulate. Nonetheless, the use of these agents particularly diuretics is viewed as a dated practice. The issue of which antihypertensive drug to use will remain complex and confusing as the marketing juggernauts of the pharmaceutical industry vigorously promote drug classes such as angiotensin- converting enzyme inhibitors, angiotensin-receptor antagonists, and calcium-channel blockers. A pharmacologic middle ground will probably be reached in the form of fixed-dose combination therapy. Diuretics and b-blockers are mechanistically rational when combined with numerous other drugs; thus, the issue of which drug should be used to begin treatment will be settled by a truce, albeit an uneasy one, favoring the increased use of fixed-dose combination antihypertensive therapy.

Allhat

“…Although we are still uncertain as to how in the long-term a thiazide-type diuretic specifically reduces BP, we do know that an early diuretic action is necessary for the long-term vasodepressor response. 17 What remains to be determined is whether the greater diuretic potency of chlorthalidone translates into a level of BP reduction in excess of what is seen with hydrochlorothiazide. This question has yet to be satisfactorily answered since head-to-head comparison trials between hydrochlorothiazide and chlorthalidone have been too few to offer meaningful comparison data.…”