resistant hypertension: are diuretics harmful?
i decided to comment extensively on a very recent review article that supports the quite provocative argument that we are treating hypertension incorrectly, especially treatment-resistant hypertension, and that we should avoid the early use of the typical diuretics and instead use spironolactone much earlier in the cascade of meds. this pretty brief article is well-referenced (59 references) to support each of their points and to justify their proposed paradigm-shift in hypertension treatment (see htn resistant diuretics harmful HTN2025 in dropbox, or . DOI: 10.1161/HYPERTENSIONAHA.125.24871): -- treatment-resistant hypertension (TRH) has historically been defined as the failure to achieve the recommended blood pressure with at least 3 classes of antihypertensive meds, including a diuretic, at target or maximally tolerated doses -- in general, the diuretics used are thiazides or chlorthalidone unless there is significant renal failure, when loop di...