Thiazides and hypertension in the elderly.
The declining use of diuretics in the treatment of elderly hypertensive patients described in the report by Monane and colleagues in this issue of Hypertension is lamentable but understandable. Lamentable because meta-analyses of randomized clinical trials in elderly hypertensive patients have shown that diuretic-based treatment leads to an impressive reduction in morbidity and mortality from stroke and coronary heart disease, as well as all-cause mortality.1 2 Elderly patients with isolated systolic hypertension (≥160/<90 mm Hg) enjoy the same benefit from diuretic-based therapy as patients with elevations of both systolic and diastolic pressures.3 Lamentable because these randomized clinical trials have influenced most of the recent national guidelines that recommend prescribing a diuretic in a low dose preferentially in the initiation of antihypertensive therapy, especially for …