Diuretics: Their Place in Individualized Therapy.

Until last year, diuretics were the most popular drug used to treat hypertension. The steady decline in their use over the past few years may have been reversed by the preference given to them by JNC-5. Regardless, they are often indicated for initial therapy in many hypertensives, including the elderly, African Americans and obese patients. They are often useful as second agents to achieve adequate control of patients with reactive fluid retention, particularly with renal insufficiency. Diuretics, however, may not be an appropriate choice for many patients. These include the large proportion of hypertensives who have concomitant disorders that could be adversely affected by the hemodynamic and metabolic alteration induced by diuretics. Therefore, a treatment plan should be determined for each patient. Such an individualized approach will provide equal antihypertensive efficacy and the potential for better management of concomitant disorders.