Strategies to improve the cardiovascular risk profile of thiazide-type diuretics as used in the management of hypertension

Thiazide diuretics are one of the preferred pharmacologic treatments for hypertension. However, there has been rather pointed debate during the past 20 years about the clinical significance of the biochemical and/or metabolic adverse effects caused by diuretics. This controversy centers around whether the hypokalemia, hypomagnesemia, hyperuricemia, hyperglycemia and/or hyperlipidemia occasionally seen with diuretics might lessen some of the beneficial effects on cardiovascular risk seen with reductions in blood pressure. One of the biggest controversies in the last few years has focused on whether the small increase in absolute risk of diabetes seen with diuretic therapy should be a concern. The vigilant clinician should appropriately dose and monitor diuretic therapy either when given alone or when used in combination therapy. When these strategies are employed, the adverse effects seen with diuretics can be minimized or negated, and in so doing cardiovascular benefits can be optimized.