Letter – Diuretics in primary hypertension – Reloaded

1 Diuretics as a first line drug in elderly hypertensives is slowly getting forgotten by many due to fear of its metabolic sideeffectsIn high dose, [16_TD$DIFF]yes it might cause problem especially Thiazide diuretics and its equivalent but with the advent of low dose chlorthalidone (12.5 [17_TD$DIFF][13_TD$DIFF]and 25mg)and Indapamide has decreased this fear. 2 Low dose chlorthalidone and indapamide has shown superiority over the thiazide diuretics in reducing the CV outcomes, systolic BP and improving the MACE events and thereby improving the mortality and morbidity benefits. 3 3 Coming to the metabolic side effects profile, even low dose chlorthalidone seem to cause metabolic imbalance to some extent, whereas indapamide either alone or in combinationwith perindropril has or showed improvement in all-cause mortality and morbidity MACE events and CV outcomes. Several trials namely PROGRESS, ADVANCE to name a few have proved it.