How effective are thiazide diuretics for the treatment of heart failure?

Donna Hill Howes, RN
Family Practitioner

Thiazide diuretics are as effective as most other blood pressure medications. When used in combination, they increase the effects of many other blood pressure medicines, so that lower doses of each can be used. People taking thiazide diuretics have lower rates of complications from high blood pressure, such as strokes, heart attacks, and heart failure. Thiazide diuretics also prevent the loss of calcium, which helps protect against osteoporosis and bone fractures.

Thiazide diuretics are less effective for people with kidney problems. Chlorthalidone is stronger than hydrochlorothiazide. It is better at controlling blood pressure during the night and in the early morning.

A thiazide diuretic (usually chlorthalidone) or a calcium channel blocker is usually the first choice of drug for black people with high blood pressure. These drugs are more effective for black people than ACE inhibitors, angiotensin receptor blockers, or beta blockers.

Thiazide diuretics are often combined with ACE inhibitors or angiotensin receptor blockers. Combinations with beta blockers, calcium channel blockers, or renin inhibitors are also effective. The combination of a thiazide diuretic with a potassium-sparing diuretic can help prevent the loss of potassium, which is a side effect of thiazide diuretics. 

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