Thiazide diuretics

Thiazide (/ˈθaɪəzaɪd/) is a type of molecule and a class of diuretics often used to treat hypertension (high blood pressure) and edema (such as that caused by heart failure, liver failure, or kidney failure).

The thiazides and thiazide-like diuretics reduce the risk of death, stroke, heart attack, and heart failure due to hypertension. The class was discovered and developed at Merck and Co. in the 1950s, and the first approved drug of this class, chlorothiazide, was marketed under the trade name Diuril beginning in 1958. In most countries, the thiazides are the cheapest antihypertensive drugs available.

Regarding effectiveness in the treatment of hypertension, a systematic review by the Cochrane Collaboration found:

Thiazides and thiazide-like diuretics have been in constant use since their introduction in 1958. They "have remained a cornerstone in the management of hypertension for more than half a century since their introduction [...] Very few agents used for the treatment of any disease can boast such staying power, which is a testament both to the efficacy and safety of these compounds."

Several clinical practice guidelines address the use of thiazides. They are the recommended first-line treatment in the US (JNC VII) guidelines for hypertension and a recommended treatment in the European (ESC/ESH) guidelines. However, the recent 2011 UK National Institute for Health and Clinical Excellence (NICE) guideline on the management of primary hypertension in adults (CG127) recommend calcium channel blockers (CCBs) as first line agents in hypertension and advise that thiazide-like diuretics should only be used first line if CCBs are not suitable or if the patient has oedema or has a high risk of developing heart failure. Thiazides have also been replaced by angiotensin converting enzyme (ACE) inhibitors in Australia due to their propensity to increase risk of diabetes mellitus type 2.

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