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Thiazides versus loop diuretics in the treatment of hypertension

Rajiv Agarwal, MD
Section Editor
George L Bakris, MD
Deputy Editor
John P Forman, MD, MSc


Diuretics, particularly thiazide-type and thiazide-like diuretics, are commonly used in the treatment of hypertension. Diuretics lower the blood pressure, at least initially, by inducing sodium and fluid loss. (See "Use of thiazide diuretics in patients with primary (essential) hypertension" and "Mechanism of action of diuretics".)

Loop diuretics are commonly used to treat edematous states. (See "General principles of the treatment of edema in adults".)

The major differences between thiazide and loop diuretics in the treatment of hypertension are discussed in this topic. The mechanism of action and side effects of diuretics, and different effects of thiazide and loop diuretics on calcium balance, are discussed in detail elsewhere. (See "Mechanism of action of diuretics" and "Use of thiazide diuretics in patients with primary (essential) hypertension", section on 'Side effects' and "Loop diuretics: Maximum effective dose and major side effects", section on 'Major side effects' and "Time course of loop and thiazide diuretic-induced electrolyte complications" and "Diuretic-induced hyperuricemia and gout" and "Diuretics and calcium balance".)


Patients without chronic kidney disease — When used in patients with primary hypertension and relatively normal renal function, the thiazide diuretics, particularly chlorthalidone and indapamide, are more effective antihypertensive drugs than the loop diuretics [1-6]. (See "Use of thiazide diuretics in patients with primary (essential) hypertension".)

The difference in efficacy is probably related to duration of action of these diuretics [4]. Commonly used loop diuretics, such as furosemide and bumetanide, have a short duration of action (less than six hours); the antihypertensive efficacy of these medications may be limited since the initial fluid loss can be counteracted by activation of the renin-angiotensin-aldosterone system, leading to sodium retention during the period when the diuretic effect has worn off [7].

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Literature review current through: Dec 2017. | This topic last updated: Oct 10, 2017.
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