Predictors to the blood pressure response and adverse side effects of thiazide diuretics

Evidence from the Antihypertensive and Lipid-Lowering to prevent Heart Attack Trial (ALLHAT) and other pivotal hypertension studies have established that thiazide-type diuretics confer significant reductions in stroke and cardiovascular events. Although challenged by other agents, up to date, thiazide diuretics remain one of the most widely recommended first-line therapy for hypertension. Given their strong record of evidence, low cost, and favorable tolerability, low-dose thiazide-type diuretics are recommended as initial therapy in most hypertensive patients and are the foundation for multiple antihypertensive drug regimens according to the Seventh Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. However, concerns have also been raised that diuretics may link to unfavorable metabolic effects, new-onset of diabetes, and adverse clinical outcomes. In this chapter, we will review the predictors to the blood pressure response and adverse side effects to thiazide diuretics. The results may give more information to the individualized antihypertensive treatment with thiazide diuretics and to prevent the side effects.