Diuretics

With the advent of new therapeutic drugs the use of diuretics in the treatment of hypertension is decreasing slowly over the last few years. Nevertheless diuretics still represent one important cornerstone in the therapy of most forms of high blood pressure. Metabolic side effects of diuretics are often used as an argument against their clinical use. Indeed the diuretic therapy may lead as a function of the dosage and the duration of the therapy to an increase of total cholesterol and an impairment of the glucose tolerance. Spironolactone and other potassium sparing diuretics are "lipid-neutral". These metabolic side effects of the diuretics can be counterbalanced by the implementation of non-pharmacological means of blood pressure therapy. Body weight control seems to be of central importance. Therapy resistant forms of hypertension may be caused by many different pathogenetic mechanisms. Besides other reasons (such as secondary hypertension, non compliance etc.) volume overload may represent one of the most important reasons of resistant forms of hypertension. Diuretics, especially also the aldosterone antagonists, play a central role in the control of most situations associated with volume overload in the setting of essential hypertension.