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(Hypertension. 1995;25:1052.)
© 1995 American Heart Association, Inc.

Articles

Thiazides and Hypertension in the Elderly

Ray W. Gifford, Jr; Norman M. Kaplan

From the Department of Nephrology and Hypertension, Cleveland (Ohio) Clinic Foundation (R.W.G.), and the Department of Internal Medicine, Southwestern Medical Center, Dallas, Tex (N.M.K.).

Correspondence to Ray W. Gifford, Jr, MD, Department of Nephrology and Hypertension, Desk A101, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195.

Key Words: aging • diuretics • elderly • epidemiology • antihypertensive agents

	Introduction

 
The declining use of diuretics in the treatment of elderly hypertensive patients described in the report by Monane and colleagues in this issue of Hypertension is lamentable but understandable. Lamentable because meta-analyses of randomized clinical trials in elderly hypertensive patients have shown that diuretic-based treatment leads to an impressive reduction in morbidity and mortality from stroke and coronary heart disease, as well as all-cause mortality.^{1 2} Elderly patients with isolated systolic hypertension (160/<90 mm Hg) enjoy the same benefit from diuretic-based therapy as patients with elevations of both systolic and diastolic pressures.³ Lamentable because these randomized clinical trials have influenced most of the recent national guidelines that recommend prescribing a diuretic in a low dose preferentially in the initiation of antihypertensive therapy, especially for elderly hypertensive patients.^{4 5}

Understandable because most of the randomized trials that have convincingly demonstrated the benefit of diuretics in managing hypertension in elderly patients, and the guidelines that were subsequently developed, have been published since 1988, when the observations by Monane and colleagues concluded. Understandable because earlier randomized trials that used diuretics in large doses (50 to 100 mg/d of hydrochlorothiazide or chlorthalidone) in young and middle-aged patients had failed to achieve the expected reduction in coronary events,⁶ leading to speculation that the metabolic side effects of diuretic therapy might have a counterproductive effect with regard to coronary disease. Without the massive marketing provided for newer agents, generic diuretics were easy targets for the trade-name alternatives included in the recommendations for initial therapy in the 1982 . . . [Full Text of this Article]

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				Prescribing Patterns Shift to Expensive Nonthiazide Diuretics Journal Watch Cardiology, June 1, 1995; 1995(601): 8 - 8. [Full Text]