loop diuretics should be reserved for the role of an adjunctive therapy in more resistant hypertension (failure to reduce BP despite combination of three antihypertensive drugs) and where renal impairment is present (1)
the evidence base regarding loop diuretics is not as substantive as that available for thiazide diuretics where studies have shown a reduction in reduction of the incidence of cardiac events in the elderly (2), as well as reduction in the risk of coronary events and stroke in younger populations (3); also thiazide diuretics have been shown to reverse target organ damage to the same extent as newer antihypertensive agents (4)
Reference:
1) Prescriber (2001), 12 (18), 49-60.
2) Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final reslts of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA (1991), 265, 3255-64.
3) Medical Research Council trial of hypertension in older adults: principal results. MRC Working Party. BMJ (1992), 304, 405-12.
4) Gosse P et al (2000). Regression of left ventricular hypertrophy in hypertensive patients treated with indapamide SR 1.5mg versus enalapril 20mg: the LIVE study. J Hypertens, 18, 1465-75.
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