Should I consider switching my hypertensive patients receiving other agents to thiazide-type diuretics?
Diuretics are most effective in reducing the cardiovascular complications of hypertension among all the agents tested in ALLHAT. In addition, the drug cost of diuretics is much lower than the cost of brand-name agents. For hypertensive patients not controlled on another drug, a thiazide-type diuretic in low to moderate dose should be added. For hypertensive patients controlled on other drug(s), a thiazide diuretic in low to moderate dose should be substituted unless there are compelling reasons not to do so. There are two reasons. First, the diuretics are most effective in reducing the cardiovascular complications of hypertension. Second, the drug cost of diuretics is much lower than the cost of brand-name agents. Of course, the decision to substitute should be made jointly by patient and physician.
