Thiazide diuretics names
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Thiazide Diuretics: Names and Classifications
Introduction to Thiazide Diuretics
Thiazide diuretics are a cornerstone in the treatment of hypertension, having been widely used for over 60 years. These diuretics work by inhibiting the Na+-Cl- cotransporter in the distal convoluted tubule of the kidney, leading to increased excretion of sodium and water, which helps lower blood pressure1 7.
Thiazide-Type vs. Thiazide-Like Diuretics
Thiazide diuretics can be broadly classified into two categories based on their chemical structure: thiazide-type and thiazide-like diuretics.
Thiazide-Type Diuretics
Thiazide-type diuretics contain the benzothiadiazine ring structure. The most commonly used thiazide-type diuretic is hydrochlorothiazide1 3. This drug is often prescribed due to its effectiveness in reducing blood pressure and its role in combination therapies with other antihypertensive agents1 10.
Thiazide-Like Diuretics
Thiazide-like diuretics, on the other hand, do not contain the benzothiadiazine ring but have similar pharmacological effects. The primary thiazide-like diuretics include chlorthalidone and indapamide1 3. These agents are known for their longer duration of action compared to thiazide-type diuretics, which can be beneficial in maintaining blood pressure control over a longer period2 4.
Comparative Efficacy and Usage
Hydrochlorothiazide vs. Chlorthalidone
Hydrochlorothiazide and chlorthalidone are often considered interchangeable in clinical practice. However, chlorthalidone is approximately 1.5 to 2 times more potent and has a longer duration of action than hydrochlorothiazide2. Despite these differences, both drugs are effective in lowering blood pressure and are widely used in hypertension management2 6.
Indapamide
Indapamide is another thiazide-like diuretic that has been shown to be effective in reducing blood pressure. It is often preferred in some guidelines due to its favorable pharmacokinetic profile and longer duration of action3 6.
Clinical Implications and Recommendations
Thiazide and thiazide-like diuretics are recommended as first-line therapy for hypertension in many international guidelines. They are effective as monotherapy and can enhance the efficacy of other antihypertensive agents when used in combination1 10. Despite their proven benefits, thiazides remain underutilized, with only about one-third of hypertensive patients receiving them1.
Conclusion
Thiazide diuretics, including thiazide-type (e.g., hydrochlorothiazide) and thiazide-like (e.g., chlorthalidone, indapamide) agents, play a crucial role in the management of hypertension. Their effectiveness, particularly in combination therapies, and their ability to reduce cardiovascular events make them indispensable in hypertension treatment regimens. Understanding the differences between these agents can help clinicians make informed decisions to optimize patient outcomes.
Sources and full results
Most relevant research papers on this topic
Thiazide and the Thiazide-Like Diuretics: Review of Hydrochlorothiazide, Chlorthalidone, and Indapamide.
Thiazides and thiazide-like diuretics effectively lower blood pressure and cardiovascular events in hypertensive patients, making them a recommended first-line treatment option.
Very Rigorous JournalHydrochlorothiazide versus chlorthalidone: evidence supporting their interchangeability.
Chlorthalidone and hydrochlorothiazide are considered interchangeable thiazide diuretics, but their pharmacokinetic and pharmacodynamic differences may cause differences in cardiovascular outcomes.
Systematic Review
Highly CitedRedefining diuretics use in hypertension: why select a thiazide-like diuretic?
Diuretics are effective in treating hypertension, with a low risk of significant metabolic effects and significant reductions in morbidity and mortality.
Very Rigorous JournalEffects of Thiazide-Type and Thiazide-Like Diuretics on Cardiovascular Events and Mortality: Systematic Review and Meta-Analysis
Thiazide-like diuretics show a 12% additional risk reduction for cardiovascular events and a 21% additional risk reduction for heart failure compared to thiazide-type diuretics.
Meta-AnalysisVery Rigorous JournalHighly CitedEffectiveness of thiazide and thiazide-like diuretics in advanced chronic kidney disease: a systematic review and meta-analysis
Thiazide and thiazide-like diuretics remain effective in lowering blood pressure in patients with advanced chronic kidney disease, despite being discouraged by treatment guidelines.
Meta-AnalysisComparison of thiazide‐like diuretics versus thiazide‐type diuretics: a meta‐analysis
Thiazide-like diuretics are superior to thiazide-type diuretics in reducing blood pressure without increasing the incidence of hypokalemia, hyponatraemia, or changes in blood glucose or serum total cholesterol.
Meta-AnalysisDiuretics in the treatment of hypertension. Part 1: thiazide and thiazide-like diuretics
Low doses of thiazide diuretics are an effective and safe treatment for hypertension, increasing the efficacy of other antihypertensive classes.
A review of the prescribing trend of thiazide‐type and thiazide‐like diuretics in hypertension: A UK perspective
UK prescriptions of thiazide diuretics declined over time, with bendroflumethiazide being the most commonly prescribed, but indapamide use increased significantly between 2010 and 2016/2017.
Literature Review
Rigorous JournalReviewing the effects of thiazide and thiazide-like diuretics as photosensitizing drugs on the risk of skin cancer.
Thiazide and thiazide-like diuretics have photosensitizing potential, and some studies with methodological limitations have linked their use to an increased risk of skin cancer.
Systematic ReviewVery Rigorous JournalUse of diuretics in patients with hypertension.
Thiazide diuretics effectively reduce blood pressure and enhance the efficacy of other antihypertensive agents, reducing hypertension-related morbidity and mortality.
Literature ReviewHighly Cited