Effect of diuretics on morbidity and mortality in the treatment of hypertension.

Diuretic-based hypertension treatment trials have universally demonstrated a reduction in cardiovascular morbidity and mortality in treated compared with placebo or control subjects. Progression to more severe hypertension has been reduced together with reversal of left ventricular hypertrophy if present and prevention of congestive heart failure. The incidence of fatal and non-fatal strokes as well as coronary heart disease events have both been significantly reduced by diuretic-based treatment. Speculation that diuretic-induced adverse effects on lipid and glucose metabolism have negated the beneficial effects of blood pressure lowering has not been substantiated. Diuretics remain one of the preferred initial therapies in the management of hypertension.