Thiazide diuretic monotherapy for hypertension: Diuretic's dark side just got darker

Diuretic monotherapy is the current recommendation of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure for initial antihypertensive therapy. There is mounting concern, however, that the benefits of diuretic's superior blood pressure control may be offset by its multiple metabolic disturbances that increase cardiovascular risk. Reungjui et al. document a new concern, nephrotoxicity by thiazide monotherapy. This and other recently published evidence of diuretic's 'dark side' is discussed.