Published online before print January 30, 2006, doi: 10.1161/01.HYP.0000203147.75714.ba
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(Hypertension. 2006;47:321.)
© 2006 American Heart Association, Inc.
Editorial Commentaries |
Chlorthalidone
Has It Always Been the Best Thiazide-Type Diuretic?
From the Section of Clinical Pharmacology and Hypertension, Division of Nephrology, Virginia Commonwealth University Health System, Richmond.
Correspondence to Domenic A. Sica, MD, Box 980160 MCV Station, Richmond, VA 23298. E-mail dsica@hsc.vcu.edu
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
Modern diuretic therapy evolved from 2 seemingly unrelated events in the 1930s: the development of sulfanilamide, the first truly effective antibacterial agent, and the description of the enzyme carbonic anhydrase. Sulfanilamide was observed to increase sodium (Na+)/potassium and water excretion by inhibition of carbonic anhydrase activity. Recognition of this action proved the impetus for synthesis of compounds, such as acetazolamide, that could more specifically inhibit carbonic anhydrase; however, acetazolamide was a short-acting compound, and diuretics with greater potency and/or duration of action were quickly sought. Chlorothiazide was the first of these new-generation diuretics, and its introduction in 1957 set the modern era of diuretic therapy in motion. Shortly thereafter several loop diuretics and a host of thiazide-type diuretics found their way to the marketplace as the result of active development programs.
As diuretics began to proliferate in numbers, loop diuretics were promptly distinguished from thiazide-type diuretics on the basis of potency and were quickly slotted as the more important diuretic class for volume overload states. Thiazide-type diuretics were early on seen as agents with greater effectiveness in reducing blood pressure (BP), but with a lesser ability to impact volume overload states. In the early days of thiazide-type diuretic use there was little effort expended to seriously distinguish one from the other in their BP-lowering effect even if there were major intraclass pharmacokinetic differences. Inexorably, the term "class effect" crept in to describe the actions of thiazide-type diuretics, applied both to BP reduction and ultimately outcomes.
Much of the recent
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Hypertension 2006 47: 352-358.
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  D. A. Calhoun, D. Jones, S. Textor, D. C. Goff, T. P. Murphy, R. D. Toto, A. White, W. C. Cushman, W. White, D. Sica, et al. Resistant Hypertension: Diagnosis, Evaluation, and Treatment: A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research Circulation, June 24, 2008; 117(25): e510 - e526. [Abstract] [Full Text] [PDF]
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 D. A. Calhoun, D. Jones, S. Textor, D. C. Goff, T. P. Murphy, R. D. Toto, A. White, W. C. Cushman, W. White, D. Sica, et al. Resistant Hypertension: Diagnosis, Evaluation, and Treatment: A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research Hypertension, June 1, 2008; 51(6): 1403 - 1419. [Abstract] [Full Text] [PDF]
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