Advantages and Limitations of Diuretic Therapy in Essential Hypertension

The diuretics previously considered the "cornerstone" of the antihypertensive treatment have recently undergone a reevaluation and have been considered as a potential cause of the lack of "cardioprotection" found in different epidemiological studies. The reduction in plasma potassium and the changes in lipoproteins should represent the mechanisms of the negative interference of diuretics at cardiac levels. In spite of this common opinion, there is no clinically consistent evidence that the lowering of serum potassium and the changes in lipoproteins are responsible for the lack of cardioprotection during antihypertensive therapy. It is possible that other causes, for instance the reflex activation of sympathetic nervous system and/or renin secretion, may play an important role in determining the cardiac effects of antihypertensive therapy. However, it is also true that diuretics have been used in the past at doses that were too high, and the changes in serum potassium and lipoproteins can be minimized by administering lower doses of diuretics without decreasing their antihypertensive efficacy.