Skip to Content

Hydrochlorothiazide

Class: Thiazide Diuretics
VA Class: CV701
CAS Number: 58-93-5
Brands: Microzide

hydroCHLOROthiazide is also contained as an ingredient in the following combinations:
Amiloride Hydrochloride and hydroCHLOROthiazide
Methyldopa and hydroCHLOROthiazide
Propranolol Hydrochloride and hydroCHLOROthiazide
Spironolactone and hydroCHLOROthiazide
Triamterene and hydroCHLOROthiazide

Medically reviewed by Drugs.com. Last updated on Jan 14, 2019.

Introduction

See also: Prolia

Thiazide diuretic and antihypertensive agent.a

Uses for Hydrochlorothiazide

Hypertension

Used alone or in combination with other antihypertensive agents for all stages of hypertension.b 501 600 601 1200

Thiazide diuretics are recommended as one of several preferred agents for the initial management of hypertension according to current evidence-based hypertension guidelines; other preferred options include ACE inhibitors, angiotensin II receptor antagonists, and calcium-channel blockers.501 502 503 504 1200 While there may be individual differences with respect to recommendations for initial drug selection and use in specific patient populations, current evidence indicates that these antihypertensive drug classes all generally produce comparable effects on overall mortality and cardiovascular, cerebrovascular, and renal outcomes.501 502 504 1200 1213

Individualize choice of therapy; consider patient characteristics (e.g., age, ethnicity/race, comorbidities, cardiovascular risk) as well as drug-related factors (e.g., ease of administration, availability, adverse effects, cost).501 502 503 504 515 1200 1201

A 2017 ACC/AHA multidisciplinary hypertension guideline classifies BP in adults into 4 categories: normal, elevated, stage 1 hypertension, and stage 2 hypertension.1200 (See Table 1.)

Source: Whelton PK, Carey RM, Aronow WS et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:e13-115.

Individuals with SBP and DBP in 2 different categories (e.g., elevated SBP and normal DBP) should be designated as being in the higher BP category (i.e., elevated BP).

Table 1. ACC/AHA BP Classification in Adults1200

Category

SBP (mm Hg)

DBP (mm Hg)

Normal

<120

and

<80

Elevated

120–129

and

<80

Hypertension, Stage 1

130–139

or

80–89

Hypertension, Stage 2

≥140

or

≥90

The goal of hypertension management and prevention is to achieve and maintain optimal control of BP.1200 However, the BP thresholds used to define hypertension, the optimum BP threshold at which to initiate antihypertensive drug therapy, and the ideal target BP values remain controversial.501 503 504 505 506 507 508 515 523 526 530 1200 1201 1207 1209 1222 1223 1229

The 2017 ACC/AHA hypertension guideline generally recommends a target BP goal (i.e., BPs to achieve with drug therapy and/or nonpharmacologic intervention) <130/80 mm Hg in all adults regardless of comorbidities or level of atherosclerotic cardiovascular disease (ASCVD) risk.1200 In addition, an SBP goal of <130 mm Hg is recommended for noninstitutionalized ambulatory patients ≥65 years of age with an average SBP of ≥130 mm Hg.1200 These BP goals are based upon clinical studies demonstrating continuing reduction of cardiovascular risk at progressively lower levels of SBP.1200 1202 1210

Previous hypertension guidelines generally have based target BP goals on age and comorbidities.501 504 536 Guidelines such as those issued by the JNC 8 expert panel generally have targeted a BP goal of <140/90 mm Hg regardless of cardiovascular risk and have used higher BP thresholds and target BPs in elderly patients compared with501 504 536 those recommended by the 2017 ACC/AHA hypertension guideline.1200

Some clinicians continue to support previous target BPs recommended by JNC 8 due to concerns about the lack of generalizability of data from some clinical trials (e.g., SPRINT study) used to support the current ACC/AHA hypertension guideline and potential harms (e.g., adverse drug effects, costs of therapy) versus benefits of BP lowering in patients at lower risk of cardiovascular disease.1222 1223 1224 1229

Consider potential benefits of hypertension management and drug cost, adverse effects, and risks associated with the use of multiple antihypertensive drugs when deciding a patient's BP treatment goal.1200 1220 1229

For decisions regarding when to initiate drug therapy (BP threshold), the current ACC/AHA hypertension guideline incorporates underlying cardiovascular risk factors.1200 1207 ASCVD risk assessment recommended by ACC/AHA for all adults with hypertension.1200

ACC/AHA currently recommend initiation of antihypertensive drug therapy in addition to lifestyle/behavioral modifications at an SBP ≥140 mm Hg or DBP ≥90 mm Hg in adults who have no history of cardiovascular disease (i.e., primary prevention) and a low ASCVD risk (10-year risk <10%).1200

For secondary prevention in adults with known cardiovascular disease or for primary prevention in those at higher risk for ASCVD (10-year risk ≥10%), ACC/AHA recommend initiation of antihypertensive drug therapy at an average SBP ≥130 mm Hg or an average DBP ≥80 mm Hg.1200

Adults with hypertension and diabetes mellitus, chronic kidney disease (CKD), or age ≥65 years are assumed to be at high risk for cardiovascular disease; ACC/AHA state that such patients should have antihypertensive drug therapy initiated at a BP ≥130/80 mm Hg.1200 Individualize drug therapy in patients with hypertension and underlying cardiovascular risk factors.502 1200

In stage 1 hypertension, experts state that it is reasonable to initiate drug therapy using the stepped-care approach in which one drug is initiated and titrated and other drugs are added sequentially to achieve the target BP.1200 Initiation of antihypertensive therapy with 2 first-line agents from different pharmacologic classes recommended in adults with stage 2 hypertension and average BP >20/10 mm Hg above BP goal.1200

Black hypertensive patients generally tend to respond better to monotherapy with thiazide diuretics or calcium-channel blockers than to other antihypertensive drug classes (e.g., ACE inhibitors, angiotensin II receptor antagonists).108 501 504 1200 However, the combination of an ACE inhibitor or an angiotensin II receptor antagonist with a calcium-channel blocker or thiazide diuretic produces similar BP lowering in black patients as in other racial groups.1200

Thiazides may be preferred in hypertensive patients with osteoporosis. Secondary beneficial effect in hypertensive geriatric patients of reducing the risk of osteoporosis secondary to effect on calcium homeostasis and bone mineralization.

Thiazide diuretics (unlike potassium-sparing diuretics) may be used in patients who are at an increased risk for developing hyperkalemia (e.g., those receiving an ACE inhibitor).112

Edema (General)

Management of edema resulting from various causes; diagnose etiology before use.b

Edema caused by renal disease or by corticosteroids or estrogens may be relatively resistant to treatment.b

Ineffective in patients with Scr or BUN concentrations greater than twice normal.b

May be ineffective in patients with a GFR of <15–25 mL/minute; even when GFR is 25–50 mL/minute, more potent (e.g., loop) diuretics may be indicated.b

No substantial difference in clinical effects or toxicity of comparable thiazide or thiazide-like diuretics, except metolazone may be more effective in edema with renal impairment.b

Edema in Heart Failure

Management of edema associated with heart failure.b c

Most experts state that all patients with symptomatic heart failure who have evidence for, or a history of, fluid retention generally should receive diuretic therapy in conjunction with moderate sodium restriction, an agent to inhibit the renin-angiotensin-aldosterone system (e.g., ACE inhibitor, angiotensin II receptor antagonist, angiotensin receptor-neprilysin inhibitor [ARNI]), a β-adrenergic blocking agent (β-blocker), and in selected patients, an aldosterone antagonist.524

Loop diuretics (e.g., bumetanide, ethacrynic acid, furosemide, torsemide) are diuretics of choice for most patients with heart failure.524

Do not use diuretics as monotherapy in heart failure even if symptoms (e.g., peripheral edema, pulmonary congestion) are well controlled; diuretics alone do not prevent progression of heart failure.

Diuretics produce rapid symptomatic benefits, relieving pulmonary and peripheral edema more rapidly (within hours or days) than cardiac glycosides, ACE inhibitors, or β-blockers (in weeks or months).

Once fluid retention has resolved in heart failure, diuretic therapy should be maintained to prevent recurrence of fluid retention. Ideally, diuretic therapy should be adjusted according to changes in body weight (as an indicator of fluid retention) rather than maintained at a fixed dosage.

Diuretics should be continued in heart failure and comorbid conditions (e.g., hypertension) where ongoing therapy with the drugs is indicated.524

Edema Secondary to Nephrotic Syndrome

May be useful if the patient fails to respond to corticosteroid therapy.b

More likely to become refractory to thiazides than edema associated with heart failure, and more potent diuretics may be required.b

Edema in Pregnancy

Generally responds well to thiazides except when caused by renal disease.b

Thiazides should not be used for routine therapy in pregnant women with mild edema who are otherwise healthy.b

Diabetes Insipidus

Has been used widely in the treatment of diabetes insipidus.b

Effective in both the neurohypophyseal and nephrogenic forms of the disease, decreasing urine volume by up to 50%.b

Particularly useful in nephrogenic diabetes insipidus, since this form of the disease is unresponsive to vasopressin or lypressin and chlorpropamide.b

Useful in patients who are allergic or refractory to vasopressin or lypressin and has been used in combination with one of these hormones and a low-salt diet in patients who excrete an exceptionally large volume of urine.b

Renal Tubular Acidosis

Has been used with success in the treatment of electrolyte disturbances associated with renal tubular acidosis.b

Renal Calculus Formation

Has been used with success in the prophylaxis of renal calculus formation associated with hypercalciuria.b

Hydrochlorothiazide Dosage and Administration

General

Monitoring and BP Treatment Goals

  • Monitor BP regularly (i.e., monthly) during therapy and adjust dosage of the antihypertensive drug until BP controlled.1200

    If unacceptable adverse effects occur, discontinue drug and initiate another antihypertensive agent from a different pharmacologic class.1200 1216

  • Assess patient's renal function and electrolytes 2–4 weeks after initiation of diuretic therapy.1200 (See Electrolyte Imbalance under Cautions.)

  • If adequate BP response not achieved with a single antihypertensive agent, either increase dosage of single drug or add a second drug with demonstrated benefit and preferably a complementary mechanism of action (e.g., ACE inhibitor, angiotensin II receptor antagonist, calcium-channel blocker).1200 1216 Many patients will require at least 2 drugs from different pharmacologic classes to achieve BP goal; if goal BP still not achieved, add a third drug.1200 1216 1220

Administration

Administer orally.a

Dosage

Individualize according to requirements and response.a Use lowest dosage necessary to produce desired clinical effect.109

If added to potent hypotensive agent regimen, initially reduce hypotensive dosage to avoid the possibility of severe hypotension.a

For the management of fluid retention associated with heart failure, experts state that diuretics should be administered at a dosage sufficient to achieve optimal volume status and relieve congestion without inducing excessively rapid reduction in intravascular volume, which could result in hypotension, renal dysfunction, or both.524

Pediatric Patients

Hypertension and Diuresis
Oral

Infants <6 months of age: Up to 3 mg/kg daily in 2 divided doses; up to 37.5 mg daily.600

Infants 6 months to 2 years of age: Usually 1–2 mg/kg daily in a single dose or 2 divided doses, up to 37.5 mg daily.600 1150

Children 2–12 years of age: 1–2 mg/kg daily in a single dose or 2 divided doses,600 1150 up to 100 mg daily.600

Hypertension: Experts recommend initiation of drug at low end of dosage range; may increase dosage every 2–4 weeks until BP controlled, maximum dosage reached, or adverse effects occur.1150

Adults

Edema
Oral

Usually, 25–100 mg daily in 1–3 divided doses.109

For management of fluid retention associated with heart failure, some experts recommend initiating hydrochlorothiazide at a low dosage (e.g., 25 mg once or twice daily) and increasing dosage (up to 200 mg daily) until urine output increases and weight decreases, generally by 0.5–1 kg daily.524

For sequential nephron blockade in the management of fluid retention (e.g., edema) in heart failure, some experts recommend an initial dosage of 25–100 mg once or twice daily in combination with a loop diuretic.524

Many patients also may respond to intermittent therapy (e.g., alternate days or 3–5 days weekly); decreases risk of excessive diuretic response and resulting electrolyte imbalance.109

Hypertension
Usual Dosage
Oral

Manufacturers recommend initial dosage of 12.5–25 mg daily; may increase to 50 mg daily given in 1 or 2 divided doses.600 601

Dosages of 25–100 mg daily (in 1 or 2 divided doses) used in randomized, controlled studies; experts recommend a dosage of 25–50 mg daily for optimal balance between efficacy and safety in the management of hypertension.501 1200

Fixed-combination Therapy
Oral

Initially, administer each drug separately to adjust dosage;a may use fixed combination if optimum maintenance dosage corresponds to drug ratio in combination preparation.a Alternatively, may initiate therapy with a fixed-combination preparation; may increase patient compliance.502 1200

Prescribing Limits

Pediatric Patients

Hypertension and Diuresis
Oral

Infants <2 years of age: Maximum 37.5 mg daily.600

Children 2–12 years of age: Maximum 100 daily.600

Adults

Edema
Oral

Management of fluid retention in heart failure: 200 mg maximum daily dosage recommended by ACCF/AHA.524

Hypertension
Oral

Dosages >50 mg daily associated with marked hypokalemia;600 some manufacturers state that such dosages not recommended.601

Special Populations

Hepatic Impairment

No specific dosage recommendations for hepatic impairment; caution because of risk of precipitating hepatic coma.a 109

Renal Impairment

No specific dosage recommendations for renal impairment; caution because of risk of precipitating azotemia.a 109

Geriatric Patients

Initiate therapy at the lowest dosage (12.5 mg daily); may adjust dosage in increments of 12.5 mg if needed.112

Cautions for Hydrochlorothiazide

Contraindications

  • Anuria.b 109

  • Known hypersensitivity to hydrochlorothiazide, other thiazides, or any ingredient in the formulation.b

  • Although manufacturers state allergy to other sulfonamide derivatives is a contraindication,109 evidence to support cross-sensitivity is limited, and history of sensitivity to sulfonamide anti-infectives (“sulfa sensitivity”) should not be considered an absolute contraindication.

Warnings/Precautions

Warnings

Hypotensive Agents

May potentiate effects of other hypotensive agents.109 Although additive or potentiated antihypertensive effects usually are used to therapeutic advantage,1200 hypotension could occur.109 b (See Interactions.)

Lupus Erythematosus

Possible exacerbation or activation of systemic lupus erythematosus.109

Lithium

Generally, do not use with lithium salts.109 (See Interactions.)

Sensitivity Reactions

Hypersensitivity

May occur with or without history of allergy or bronchial asthma.109

Sulfonamide cross-sensitivity unlikely. (See Contraindications under Cautions.)

General Precautions

Electrolyte Imbalance

Monitor for fluid or electrolyte imbalance (hyponatremia, hypochloremic alkalosis, hypokalemia).b 109

Observe for signs of electrolyte imbalance (e.g., dryness of mouth, thirst, weakness, lethargy, drowsiness, restlessness, confusion, seizures, oliguria, muscle pains, cramps, muscular fatigue, hypotension, tachycardia, nausea, vomiting).109

Perform periodic serum electrolyte determinations (particularly of potassium, sodium, chloride, and bicarbonate); institute measures to maintain normal serum concentrations if necessary.b

Serum and urinary electrolyte measurements are especially important with diabetes mellitus, vomiting, diarrhea, parenteral fluid therapy, or expectations of excessive diuresis.b

Weekly (or more frequent) electrolyte measurement recommended early in treatment; possible to extend interval between measurements to ≥3 months when electrolyte response has stabilized.b

Hypokalemia

May occur after brisk diuresis, when cirrhosis is present, or with prolonged therapy; inadequate oral electrolyte intake may contribute.109

May cause cardiac arrhythmias, exaggerate cardiac response to cardiac glycoside toxicity (increase ventricular irritability).109

Use potassium-sparing diuretics and/or potassium supplementation to avoid or treat hypokalemia.109

Hypochloremia

Generally mild, usually does not require specific treatment except in renal or hepatic impairment.109

Chloride replacement may be required for metabolic acidosis.109

Hyponatremia

Dilutional hyponatremia may occur in edematous patients in hot weather; appropriate treatment usually is water restriction rather than salt administration except when hyponatremia is life-threatening.109

In actual salt depletion, appropriate replacement is treatment of choice.109

Gout

Hyperuricemia or, rarely, precipitation of gout may occur; generally avoid or use with caution in patients with history of gout unless patient is receiving uric acid lowering therapy.109 502 1200

Hyperglycemia

In diabetic patients, dosage adjustment of insulin or oral hypoglycemics may be required; hyperglycemia may occur and latent diabetes mellitus may become evident.109

Sympathectomy

Antihypertensive effect may be enhanced after sympathectomy.109

Hypomagnesemia

May increase magnesium urinary excretion, resulting in hypomagnesemia.109

Hypercalcemia

May decrease calcium urinary excretion, cause slight intermittent serum calcium increase in absence of known calcium metabolism disorder; marked hypercalcemia may indicate hyperparathyroidism.109

Discontinue prior to performing parathyroid tests.109

Hyperlipidemia

May increase cholesterol and triglyceride concentrations.109

Clinical importance of these changes is unknown.b Diet low in saturated fat and cholesterol usually compensates.b

Hypotensive Effects

Orthostatic hypotension rarely occurs.b

Specific Populations

Pregnancy

Category B.109

Diuretics are considered second-line agents for control of chronic hypertension in pregnant women;142 if initiation of antihypertensive therapy is necessary during pregnancy, other antihypertensives (i.e., methyldopa, nifedipine, labetalol) are preferred.142 540

Diuretics are not recommended for prevention or management of gestational hypertension or preeclampsia.141 539 540

Edema associated with pregnancy generally responds well to thiazides except when caused by renal disease; however, do not use as routine therapy in pregnant women with mild edema who are otherwise healthy.b

Lactation

Distributed into milk.h 109 141 Manufacturer states to discontinue nursing or the drug;109 however, considered to be compatible with breast-feeding.141

Pediatric Use

No controlled studies in children; use is supported by experience and published literature about hypertension treatment in children.109

Geriatric Use

Elderly may be at increased risk of dilutional hyponatremia, especially underweight females with poor oral fluid and electrolyte intake or excessive low-sodium nutritional supplement intake.b (See Hyponatremia under Cautions.)

Increased incidence of adverse effects and excessive reduction in BP in those >65 years of age.112 (See Geriatric Patients under Dosage and Administration.)

Hepatic Impairment

Use with caution in hepatic impairment or progressive liver disease (particularly with associated potassium deficiency); electrolyte imbalance may precipitate hepatic coma.b 109

Discontinue immediately if signs of impending hepatic coma appear.b

Renal Impairment

Use with caution in severe renal impairment; thiazides decrease GFR and may precipitate azotemia.b 109 Effects may be cumulative in impaired renal function.b 109

Consider interruption or discontinuance if progressive renal impairment (rising nonprotein nitrogen, BUN, or Scr) occurs.109

Common Adverse Effects

Potassium depletion, hyperuricemia (usually asymptomatic rarely leading to gout).b Hypochloremic alkalosis in patients at risk (e.g., hypokalemic patients).b Hyperglycemia and glycosuria in diabetics.b

Interactions for Hydrochlorothiazide

Specific Drugs and Laboratory Tests

Drug or Test

Interaction

Comments

Alcohol

Increased risk of postural hypotension with thiazidesb

Amphetamine

Thiazides may cause slightly more alkaline urinary pH; may decrease urinary excretion of some amines (e.g., amphetamine) with concurrent useb

Urine pH change is not great during thiazide use and, toxic blood concentrations of amines usually do not occurb

Monitor for signs of toxicity after initiation of thiazides in patients receiving amphetamineb

Amphotericin B

Additive/potentiated potassium loss b

Severe potassium depletion may occur when used concomitantlyb

Anticoagulants, oral

Postulated that may antagonize oral anticoagulant effectsb

Confirmatory evidence is lackingb

Antidiabetic agents (sulfonylureas)

Thiazide hyperglycemic effect may exacerbate diabetes mellitus, increase antidiabetic agent requirements, and/or cause temporary loss of diabetic control or secondary failure to antidiabetic agentb

Barbiturates

Increased risk of postural hypotension with thiazidesb

Cholestyramine or colestipol resin

May bind thiazides, reduce their GI absorption, with cholestyramine reportedly producing greater binding in vitrob

Administer thiazides at least 2 hours before cholestyramine or colestipol when used concomitantlyb

Corticosteroids

Additive/potentiated potassium loss b

Severe potassium depletion may occur when used concomitantlyb

Corticotropin

Additive/potentiated potassium loss b

Severe potassium depletion may occur when used concomitantlyb

Diazoxide

May potentiate diazoxide hyperglycemic, hypotensive, and hyperuricemic effectsb

Use concomitantly with cautionb

Digitalis glycosides

Thiazide-induced electrolyte disturbances (principally hypokalemia, but also hypomagnesemia and hypercalcemia) may increase digitalis toxicity riskb

Perform periodic electrolyte determinations with concomitant use; correct hypokalemia if warrantedb

Hypotensive agents

Increased hypotensive effects of most other hypotensive agents b

Addition of thiazide to stabilized regimen with potent hypotensive agent (e.g., guanethidine sulfate, methyldopa, ganglionic blocking agent) may cause severe postural hypotensionb

Usually used to therapeutic advantageb

Insulin

May exacerbate diabetes mellitus, increase insulin requirements, cause temporary loss of diabetic control, or secondary failure to insulinb

Lithium

Thiazides (sometimes used with lithium to reduce lithium-induced polyuria) reduced renal lithium clearance within several daysb

Can increase serum lithium concentrations and the risk of lithium intoxicationb

Occasionally used to therapeutic advantage to reduce lithium-induced polyuria, but reduce lithium dosage by about 50% and monitor serum lithium carefully.b Generally, avoid concomitant use because of increased lithium toxicity risk.b

Methenamine

Urinary alkalinization may decrease the effectiveness of methenamine compounds which require a urinary pH of ≤5.5 for optimal activityb

Monitor urine pH during concurrent therapyb

Neuromuscular blocking agents (e.g., tubocurarine chloride or gallamine triethiodide [both no longer commercially available in the US])

May cause prolonged neuromuscular blockadeb

Confirmatory evidence lackingb

NSAIAs

Increased risk of NSAIA-induced renal failure secondary to prostaglandin inhibition and decreased renal blood flowb

NSAIAs may interfere with the natriuretic, diuretic, and antihypertensive response to diuretics b

Monitor closely for possible adverse effects and/or attenuation of diuretic-induced therapeutic effects during concomitant useb

Opiates

Increased risk of postural hypotension with thiazidesb

Probenecid

Blocks thiazide-induced uric acid retentionb

Also blocks renal tubular secretion of thiazide, but effect on thiazide duration of action apparently not studiedb

Apparently enhances excretion of calcium, magnesium, and citrate during thiazide therapy, but urinary calcium concentrations remain below normalb

Sodium, potassium, ammonia, chloride, bicarbonate, phosphate, and titratable acid excretion apparently not affected by concomitant probenecid and thiazide therapyb

Used to therapeutic advantageb

Quinidine

Thiazides may cause slightly more alkaline urinary pH; may decrease urinary excretion of some amines (e.g., quinidine) with concurrent useb

Urine pH change is not great during thiazide use, and toxic blood concentrations of amines usually do not occurb

Monitor for signs of toxicity after initiation of thiazideb

Test, Amylase (serum)

Values may be increased substantially in both asymptomatic patients and in patients developing acute pancreatitis who are receiving thiazidesb

Test, Corticosteroids (urinary) (Glenn-Nelson technique)

Decreased values by interfering in vitro with the absorbance in the modified Glenn-Nelson technique for urinary 17-hydroxycorticosteroids; may also decrease urinary cortisol excretionb

Importance of effect on urinary corticosteroids is unclearb

Test, Estrogens (spectrophotometric assay of total urinary estrogen; assay of estradiol)

Hydrochlorothiazide causes falsely decreased values by interfering with formation of the Kober chromogen, and with the assay of estriol by degrading estriol at the acid hydrolytic stage of the assay; does not occur with chlorothiazideb

Test, Histamine for pheochromocytoma

False-negative resultsb

Test, Parathyroid function tests

May elevate serum calcium in the absence of known disorders of calcium metabolismb

Discontinue thiazides prior to performing parathyroid function testsb

Test, Phenolsulfonphthalein (PSP)

Thiazides compete with PSP for secretion by the proximal renal tubulesb

Importance unknownb

Test, Phentolamine

False-negative resultsb

Test, Protein-bound iodine (PBI)

Values may be decreased, although usually not to subnormalb

Test, Triiodothyronine resin uptake

Decreased slightly, but 24-hour I 131 uptake is not affectedb

Test, Tyramine

False-negative resultsb

Vasopressors (e.g., norepinephrine)

Possible decreased arterial responsiveness to vasopressor amines b

Clinical importance not established;b decrease in pressor response not sufficient to preclude vasopressor use109

Hydrochlorothiazide Pharmacokinetics

Absorption

Bioavailability

Variable absorption from GI tract.b

Onset

Diuretic effect: Within 2 hours; peak effect in 3–6 hours.b 109

Hypotensive effect: Generally 3–4 days.b

Duration

Diuretic effect: 6–12 hours.b 109

Food

Food decreases rate and extent of absorption of Microzide capsules.112

Distribution

Extent

Distributed in the extracellular space.a b

Does not cross blood-brain barrier.a

Readily crosses the placenta.a b 141

Distributed into breast milk.a h 141

Elimination

Metabolism

Not metabolized.a

Elimination Route

Excreted unchanged in urine;a ≥61% eliminated in 24 hours.a

Half-life

5.6–15 hours.a

Special Populations

In patients with uncompensated heart failure or impaired renal function, excretion may be delayed.b Effect of hemodialysis on elimination of the drug has not been determined.112

Stability

Storage

Oral

Capsules

Tight containers at <40°C, preferably at 15–30°C; protect from light, moisture, and freezing.112

Oral Solution

Tight containers at <40°C, preferably at 15–30°C.a Avoid freezing.a

Tablets

Tight containers at <40°C, preferably at 15–30°C; protect from light, moisture, and freezing.109 a

Actions

  • Exact mechanism of diuretic action is unclear; may act by altering metabolism of the tubular cells.b

  • Enhances excretion of sodium, chloride, and water by interfering with the transport of sodium ions across the renal tubular epithelium.b

  • Primary site of diuretic action appears to be the cortical diluting segment of the nephron.b

  • GFR decreases, but unclear whether secondary to a direct effect on renal vasculature or to the decrease in intravascular fluid volume or an increase in tubular pressure caused by the inhibition of sodium and water reabsorption.b The fall in GFR is not important in the mechanism of action.b

  • Enhances urinary excretion of potassium secondary to increased amount of sodium at distal tubular site of sodium-potassium exchange.b

  • Increases urinary bicarbonate excretion (although to a lesser extent than chloride excretion) but change in urinary pH is usually minimal; diuretic efficacy is not affected by the acid-base balance of the patient.b

  • Hypocalciuric effect is thought to result from a decrease in extracellular fluid (ECF) volume, although calcium reabsorption in the nephron may be increased; also, slight or intermittent elevations in serum calcium concentration.b

  • Rate of uric acid excretion is decreased, probably because of competitive inhibition of uric acid secretion or a decrease in ECF volume and a secondary increase in uric acid reabsorption.b

  • Hypotensive activity in hypertensive patients; also augments the action of other hypotensive agents.b Precise mechanism of hypotensive action has not been determined, but postulated that part of this effect is caused by direct arteriolar dilation.b

Advice to Patients

  • Advise patient of signs of electrolyte imbalance (e.g., dryness of the mouth, thirst, weakness, lethargy, drowsiness, restlessness, confusion, seizures, oliguria, muscle pains or cramps, muscular fatigue, hypotension, tachycardia, GI disturbances such as nausea and vomiting).b

  • Advise patients of importance of compliance with scheduled determinations of serum electrolyte concentrations (particularly potassium, sodium, chloride, and bicarbonate).b

  • Advise hypertensive patients of importance of continuing lifestyle/behavioral modifications that include weight reduction (for those who are overweight or obese), dietary changes to include foods that are rich in potassium and calcium and moderately restricted in sodium (adoption of the Dietary Approaches to Stop Hypertension [DASH] eating plan), increased physical activity, smoking cessation, and moderation of alcohol intake.1200

    Advise that lifestyle/behavioral modifications reduce BP, enhance antihypertensive drug efficacy, and decrease cardiovascular risk and remain an indispensable part of the management of hypertension.1200

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses.

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.

  • Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

hydroCHLOROthiazide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules

12.5 mg*

Hydrochlorothiazide Capsules

Microzide

Watson

Tablets

12.5 mg*

Hydrochlorothiazide Tablets

25 mg*

Hydrochlorothiazide Tablets

50 mg*

Hydrochlorothiazide Tablets

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Amiloride Hydrochloride and hydroCHLOROthiazide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

5 mg of Anhydrous Amiloride Hydrochloride and Hydrochlorothiazide 50 mg*

Amiloride Hydrochloride and Hydrochlorothiazide Tablets

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Captopril and hydroCHLOROthiazide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

25 mg Captopril and Hydrochlorothiazide 15 mg*

Captopril and Hydrochlorothiazide Tablets

25 mg Captopril and Hydrochlorothiazide 25 mg*

Captopril and Hydrochlorothiazide Tablets

50 mg Captopril and Hydrochlorothiazide 15 mg*

Captopril and Hydrochlorothiazide Tablets

50 mg Captopril and Hydrochlorothiazide 25 mg*

Captopril and Hydrochlorothiazide Tablets

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Enalapril Maleate and hydroCHLOROthiazide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

5 mg Enalapril Maleate and Hydrochlorothiazide 12.5 mg*

Enalapril Maleate and Hydrochlorothiazide Tablets

10 mg Enalapril Maleate and Hydrochlorothiazide 25 mg*

Enalapril Maleate and Hydrochlorothiazide Tablets

Vaseretic

Valeant

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Methyldopa and hydroCHLOROthiazide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets, film-coated

250 mg Methyldopa and Hydrochlorothiazide 15 mg*

Methyldopa and Hydrochlorothiazide Tablets

250 mg Methyldopa and Hydrochlorothiazide 25 mg*

Methyldopa and Hydrochlorothiazide Tablets

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Metoprolol Tartrate and hydroCHLOROthiazide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

50 mg Metoprolol Tartrate and Hydrochlorothiazide 25 mg*

Lopressor HCT (scored)

Validus

Metoprolol Tartrate and Hydrochlorothiazide Tablets

100 mg Metoprolol Tartrate and Hydrochlorothiazide 25 mg*

Lopressor HCT (scored)

Validus

Metoprolol Tartrate and Hydrochlorothiazide Tablets

100 mg Metoprolol Tartrate and Hydrochlorothiazide 50 mg*

Lopressor HCT (scored)

Validus

Metoprolol Tartrate and Hydrochlorothiazide Tablets

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Propranolol Hydrochloride and hydroCHLOROthiazide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

40 mg Propranolol Hydrochloride and Hydrochlorothiazide 25 mg*

Propranolol Hydrochloride and Hydrochlorothiazide Tablets

80 mg Propranolol Hydrochloride and Hydrochlorothiazide 25 mg*

Propranolol Hydrochloride and Hydrochlorothiazide Tablets

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Spironolactone and hydroCHLOROthiazide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets, film-coated

25 mg Spironolactone and Hydrochlorothiazide 25 mg*

Aldactazide

Pfizer

Spironolactone and Hydrochlorothiazide Tablets

50 mg Spironolactone and Hydrochlorothiazide 50 mg

Aldactazide (scored)

Pfizer

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Triamterene and hydroCHLOROthiazide (Co-triamterzide)

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules

37.5 mg Triamterene and Hydrochlorothiazide 25 mg*

Dyazide

GlaxoSmithKline

Triameterene and Hydrochlorothiazide Capsules

Tablets

37.5 mg Triamterene and Hydrochlorothiazide 25 mg*

Maxzide (scored)

Mylan

Triameterene and Hydrochlorothiazide Tablets

75 mg Triamterene and Hydrochlorothiazide 50 mg*

Maxzide (scored)

Mylan

Triameterene and Hydrochlorothiazide Tablets

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Other hydroCHLOROthiazide Combinations

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

12.5 mg with Candesartan 16 mg

Atacand HCT

AstraZeneca

12.5 mg with Candesartan 32 mg

Atacand HCT

AstraZeneca

12.5 mg with Fosinopril Sodium 10 mg*

Fosinopril Sodium and hydroCHLOROthiazide Tablets

12.5 mg with Fosinopril Sodium 20 mg*

Fosinopril Sodium and hydroCHLOROthiazide Tablets

12.5 mg with Irbesartan 150 mg

Avalide

Bristol-Myers Squibb, (also promoted by Sanofi-Synthelabo)

12.5 mg with Irbesartan 300 mg

Avalide

Bristol-Myers Squibb, (also promoted by Sanofi-Synthelabo)

12.5 mg with Lisinopril 10 mg*

Lisinopril and Hydrochlorothiazide Tablets

Prinzide

Merck

Zestoretic

AstraZeneca

12.5 mg with Lisinopril 20 mg*

Lisinopril and Hydrochlorothiazide Tablets

Prinzide

Merck

Zestoretic

AstraZeneca

12.5 mg with Telmisartan 40 mg*

Micardis HCT

Boehringer Ingelheim

Telmisartan and Hydrochlorothiazide Tablets

12.5 mg with Telmisartan 80 mg*

Micardis HCT

Boehringer Ingelheim

Telmisartan and Hydrochlorothiazide Tablets

25 mg with Irbesartan 300 mg

Avalide

Bristol-Myers Squibb, (also promoted by Sanofi-Synthelabo)

25 mg with Lisinopril 20 mg*

Lisinopril and Hydrochlorothiazide Tablets

Prinzide

Merck

Zestoretic

AstraZeneca

25 mg with Telmisartan 80 mg*

Micardis HCT

Boehringer Ingelheim

Telmisartan and Hydrochlorothiazide Tablets

Tablets, film-coated

6.25 mg with Benazepril Hydrochloride 5 mg*

Benazepril Hydrochloride and Hydrochlorothiazide Tablets

Lotensin HCT (scored)

Novartis

6.25 mg with Bisoprolol Fumarate 2.5 mg*

Bisoprolol Fumarate and Hydrochlorothiazide Tablets

Ziac

Duramed

6.25 mg with Bisoprolol Fumarate 5 mg*

Bisoprolol Fumarate and Hydrochlorothiazide Tablets

Ziac

Duramed

6.25 mg with Bisoprolol Fumarate 10 mg*

Bisoprolol Fumarate and Hydrochlorothiazide Tablets

Ziac

Duramed

12.5 mg with Aliskiren Hemifumarate 150 mg (of aliskiren) and Amlodipine Besylate 5 mg (of amlodipine)

Amturnide

Novartis

12.5 mg with Aliskiren Hemifumarate 300 mg (of aliskiren) and Amlodipine Besylate 5 mg (of amlodipine)

Amturnide

Novartis

12.5 mg with Aliskiren Hemifumarate 300 mg (of aliskiren) and Amlodipine Besylate 10 mg (of amlodipine)

Amturnide

Novartis

12.5 mg with Amlodipine Besylate 5 mg (of amlodipine) and Olmesartan Medoxomil 20 mg

Tribenzor

Daiichi Sankyo

12.5 mg with Amlodipine Besylate 5 mg (of amlodipine) and Olmesartan Medoxomil 40 mg

Tribenzor

Daiichi Sankyo

12.5 mg with Amlodipine Besylate 5 mg (of amlodipine) and Valsartan 160 mg*

Amlodipine Besylate, Valsartan, and Hydrochlorothiazide Tablets

Exforge HCT

Novartis

12.5 mg with Amlodipine Besylate 10 mg (of amlodipine) and Olmesartan Medoxomil 40 mg

Tribenzor

Daiichi Sankyo

12.5 mg with Amlodipine Besylate 10 mg (of amlodipine) and Valsartan 160 mg*

Amlodipine Besylate, Valsartan, and Hydrochlorothiazide Tablets

Exforge HCT

Novartis

12.5 mg with Benazepril Hydrochloride 10 mg*

Benazepril Hydrochloride and Hydrochlorothiazide Tablets

Lotensin HCT (scored)

Novartis

12.5 mg with Benazepril Hydrochloride 20 mg

Benazepril Hydrochloride and Hydrochlorothiazide Tablets

Lotensin HCT (scored)

Novartis

12.5 mg with Eprosartan Mesylate 600 mg (of eprosartan)

Teveten HCT

Abbott

12.5 mg with Losartan Potassium 50 mg

Hyzaar

Merck

12.5 mg with Losartan Potassium 100 mg

Hyzaar

Merck

12.5 mg with Moexipril Hydrochloride 7.5 mg*

Moexipril Hydrochloride and Hydrochlorothiazide Tablets

Uniretic (scored)

UCB

12.5 mg with Moexipril 15 mg*

Moexipril Hydrochloride and Hydrochlorothiazide Tablets

Uniretic (scored)

UCB

12.5 mg with Olmesartan Medoxomil 20 mg

Benicar HCT

Daiichi-Sankyo

12.5 mg with Olmesartan Medoxomil 40 mg

Benicar HCT

Daiichi-Sankyo

12.5 mg with Quinapril Hydrochloride 10 mg (of quinapril)*

Accuretic (scored)

Pfizer

Quinapril Hydrochloride and Hydrochlorothiazide Tablets

12.5 mg with Quinapril Hydrochloride 20 mg (of quinapril)*

Accuretic (scored)

Pfizer

Quinapril Hydrochloride and Hydrochlorothiazide Tablets

12.5 mg with Valsartan 80 mg*

Diovan HCT

Novartis

Valsartan and Hydrochlorothiazide Tablets

12.5 mg with Valsartan 160 mg*

Diovan HCT

Novartis

Valsartan and Hydrochlorothiazide Tablets

12.5 mg with Valsartan 320 mg*

Diovan HCT

Novartis

Valsartan and Hydrochlorothiazide Tablets

25 mg with Aliskiren Hemifumarate 300 mg (of aliskiren) and Amlodipine Besylate 5 mg (of amlodipine)

Amturnide

Novartis

25 mg with Aliskiren Hemifumarate 300 mg (of aliskiren) and Amlodipine Besylate 10 mg (of amlodipine)

Amturnide

Novartis

25 mg with Amlodipine Besylate 5 mg (of amlodipine) and Olmesartan Medoxomil 40 mg

Tribenzor

Daiichi Sankyo

25 mg with Amlodipine Besylate 5 mg (of amlodipine) and Valsartan 160 mg*

Amlodipine Besylate, Valsartan, and Hydrochlorothiazide Tablets

Exforge HCT

Novartis

25 mg with Amlodipine Besylate 10 mg (of amlodipine) and Olmesartan Medoxomil 40 mg

Tribenzor

Daiichi Sankyo

25 mg with Amlodipine Besylate 10 mg (of amlodipine) and Valsartan 160 mg*

Amlodipine Besylate, Valsartan, and Hydrochlorothiazide Tablets

Exforge HCT

Novartis

25 mg with Amlodipine Besylate 10 mg (of amlodipine) and Valsartan 320 mg*

Amlodipine Besylate, Valsartan, and Hydrochlorothiazide Tablets

Exforge HCT

Novartis

25 mg with Benazepril Hydrochloride 20 mg*

Benazepril Hydrochloride and Hydrochlorothiazide Tablets

Lotensin HCT (scored)

Novartis

25 mg with Eprosartan Mesylate 600 mg (of eprosartan)

Teveten HCT

Abbott

25 mg with Losartan Potassium 100 mg

Hyzaar

Merck

25 mg with Moexipril Hydrochloride 15 mg*

Moexipril Hydrochloride and Hydrochlorothiazide Tablets

Uniretic (scored)

UCB

25 mg with Olmesartan Medoxomil 40 mg

Benicar HCT

Daiichi-Sankyo

25 mg with Quinapril Hydrochloride 20 mg (of quinapril)*

Accuretic (scored)

Pfizer

Quinapril Hydrochloride and Hydrochlorothiazide Tablets

25 mg with Valsartan 160 mg*

Diovan HCT

Novartis

Valsartan and Hydrochlorothiazide Tablets

25 mg with Valsartan 320 mg*

Diovan HCT

Novartis

Valsartan and Hydrochlorothiazide Tablets

AHFS DI Essentials™. © Copyright 2019, Selected Revisions January 14, 2019. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

Only references cited for selected revisions after 1984 are available electronically.

103. Izzo JL, Levy D, Black HR. Importance of systolic blood pressure in older Americans. Hypertension. 2000; 35:1021-4. http://www.ncbi.nlm.nih.gov/pubmed/10818056?dopt=AbstractPlus

104. Frohlich ED. Recognition of systolic hypertension for hypertension. Hypertension. 2000; 35:1019-20. http://www.ncbi.nlm.nih.gov/pubmed/10818055?dopt=AbstractPlus

105. Bakris GL, Williams M, Dworkin L et al. Preserving renal function in adults with hypertension and diabetes: a consensus approach. Am J Kidney Dis. 2000; 36:646-61. http://www.ncbi.nlm.nih.gov/pubmed/10977801?dopt=AbstractPlus

106. Associated Press (American Diabetes Association). Diabetics urged: drop blood pressure. Chicago, IL; 2000 Aug 29. Press Release from web site. http://www.diabetes.org/newsroom/

107. Appel LJ. The verdict from ALLHAT—thiazide diuretics are the preferred initial therapy for hypertension. JAMA. 2002; 288:3039-42. http://www.ncbi.nlm.nih.gov/pubmed/12479770?dopt=AbstractPlus

108. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002; 288:2981-97. http://www.ncbi.nlm.nih.gov/pubmed/12479763?dopt=AbstractPlus

109. Merck & Co., Inc. HydroDiuril (hydrochlorothiazide) tablets prescribing information. West Point, PA; 1998 Jun.

112. Microzide capsules (hydrocholorothiazide 12.5 mg) prescribing information. Watson Pharmaceuticals, Inc. Corona, CA; 2003 Apr.

141. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk. 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011:255-8.

142. ACOG task force on hypertension in pregnancy: hypertension in pregnancy. Washington, DC: American College of Obstetricians and Gynecologists; 2013.

218. National Kidney Foundation Guideline. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Kidney Disease Outcome Quality Initiative. Am J Kidney Dis. 2002; 39(Suppl 2):S1-246.

501. James PA, Oparil S, Carter BL et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014; 311:507-20. http://www.ncbi.nlm.nih.gov/pubmed/24352797?dopt=AbstractPlus

502. Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013; 31:1281-357. http://www.ncbi.nlm.nih.gov/pubmed/23817082?dopt=AbstractPlus

503. Go AS, Bauman MA, Coleman King SM et al. An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. Hypertension. 2014; 63:878-85. http://www.ncbi.nlm.nih.gov/pubmed/24243703?dopt=AbstractPlus

504. Weber MA, Schiffrin EL, White WB et al. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hypertens (Greenwich). 2014; 16:14-26. http://www.ncbi.nlm.nih.gov/pubmed/24341872?dopt=AbstractPlus

505. Wright JT, Fine LJ, Lackland DT et al. Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patients aged 60 years or older: the minority view. Ann Intern Med. 2014; 160:499-503. http://www.ncbi.nlm.nih.gov/pubmed/24424788?dopt=AbstractPlus

506. Mitka M. Groups spar over new hypertension guidelines. JAMA. 2014; 311:663-4. http://www.ncbi.nlm.nih.gov/pubmed/24549531?dopt=AbstractPlus

507. Peterson ED, Gaziano JM, Greenland P. Recommendations for treating hypertension: what are the right goals and purposes?. JAMA. 2014; 311:474-6. http://www.ncbi.nlm.nih.gov/pubmed/24352710?dopt=AbstractPlus

508. Bauchner H, Fontanarosa PB, Golub RM. Updated guidelines for management of high blood pressure: recommendations, review, and responsibility. JAMA. 2014; 311:477-8. http://www.ncbi.nlm.nih.gov/pubmed/24352759?dopt=AbstractPlus

511. JATOS Study Group. Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients (JATOS). Hypertens Res. 2008; 31:2115-27. http://www.ncbi.nlm.nih.gov/pubmed/19139601?dopt=AbstractPlus

515. Thomas G, Shishehbor M, Brill D et al. New hypertension guidelines: one size fits most?. Cleve Clin J Med. 2014; 81:178-88. http://www.ncbi.nlm.nih.gov/pubmed/24591473?dopt=AbstractPlus

523. Fihn SD, Gardin JM, Abrams J et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012; 126:e354-471.

524. WRITING COMMITTEE MEMBERS, Yancy CW, Jessup M et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013; 128:e240-327.

526. Kernan WN, Ovbiagele B, Black HR et al. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2014; :. http://www.ncbi.nlm.nih.gov/pubmed/24788967?dopt=AbstractPlus

530. Myers MG, Tobe SW. A Canadian perspective on the Eighth Joint National Committee (JNC 8) hypertension guidelines. J Clin Hypertens (Greenwich). 2014; 16:246-8. http://www.ncbi.nlm.nih.gov/pubmed/24641124?dopt=AbstractPlus

535. Taler SJ, Agarwal R, Bakris GL et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for management of blood pressure in CKD. Am J Kidney Dis. 2013; 62:201-13. http://www.ncbi.nlm.nih.gov/pubmed/23684145?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=3929429&blobtype=pdf

536. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int Suppl. 2012: 2: 337-414.

539. Churchill D, Beevers GD, Meher S et al. Diuretics for preventing pre-eclampsia. Cochrane Database Syst Rev. 2007; :CD004451.

540. Magee LA, Pels A, Helewa M et al., for the Canadian Hypertensive Disorders of Pregnancy (HDP) Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Pregnancy Hypertens. 2014; 4:105-45. http://www.ncbi.nlm.nih.gov/pubmed/26104418?dopt=AbstractPlus

541. Perk J, De Backer G, Gohlke H et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012; 33:1635-701. http://www.ncbi.nlm.nih.gov/pubmed/22555213?dopt=AbstractPlus

600. Teva Pharmaceuticals. Hydrochlorothiazide tablets prescribing information. North Wales, PA; 2016 May.

601. Watson. Microzide (hydrochlorothiazide 12.5 mg) capsules prescribing information. Parsippany, NJ; 2011 Oct.

1150. Flynn JT, Kaelber DC, Baker-Smith CM et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017; 140 http://www.ncbi.nlm.nih.gov/pubmed/28827377?dopt=AbstractPlus

1200. Whelton PK, Carey RM, Aronow WS et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018; 71:el13-e115. http://www.ncbi.nlm.nih.gov/pubmed/29133356?dopt=AbstractPlus

1201. Bakris G, Sorrentino M. Redefining hypertension - assessing the new blood-pressure guidelines. N Engl J Med. 2018; 378:497-499. http://www.ncbi.nlm.nih.gov/pubmed/29341841?dopt=AbstractPlus

1202. Carey RM, Whelton PK, 2017 ACC/AHA Hypertension Guideline Writing Committee. Prevention, detection, evaluation, and management of high blood pressure in adults: synopsis of the 2017 American College of Cardiology/American Heart Association hypertension guideline. Ann Intern Med. 2018; 168:351-358. http://www.ncbi.nlm.nih.gov/pubmed/29357392?dopt=AbstractPlus

1207. Burnier M, Oparil S, Narkiewicz K et al. New 2017 American Heart Association and American College of Cardiology guideline for hypertension in the adults: major paradigm shifts, but will they help to fight against the hypertension disease burden?. Blood Press. 2018; 27:62-65. http://www.ncbi.nlm.nih.gov/pubmed/29447001?dopt=AbstractPlus

1209. Qaseem A, Wilt TJ, Rich R et al. Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: a clinical practice guideline From the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2017; 166:430-437. http://www.ncbi.nlm.nih.gov/pubmed/28135725?dopt=AbstractPlus

1210. SPRINT Research Group, Wright JT, Williamson JD et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015; 373:2103-16. http://www.ncbi.nlm.nih.gov/pubmed/26551272?dopt=AbstractPlus

1213. Reboussin DM, Allen NB, Griswold ME et al. Systematic review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017; http://www.ncbi.nlm.nih.gov/pubmed/29146534?dopt=AbstractPlus

1216. Taler SJ. Initial Treatment of Hypertension. N Engl J Med. 2018; 378:636-644. http://www.ncbi.nlm.nih.gov/pubmed/29443671?dopt=AbstractPlus

1220. Cifu AS, Davis AM. Prevention, detection, evaluation, and management of high blood pressure in adults. JAMA. 2017; 318:2132-2134. http://www.ncbi.nlm.nih.gov/pubmed/29159416?dopt=AbstractPlus

1222. Bell KJL, Doust J, Glasziou P. Incremental benefits and harms of the 2017 American College of Cardiology/American Heart Association high blood pressure guideline. JAMA Intern Med. 2018; 178:755-7. http://www.ncbi.nlm.nih.gov/pubmed/29710197?dopt=AbstractPlus

1223. LeFevre M. ACC/AHA hypertension guideline: What is new? What do we do?. Am Fam Physician. 2018; 97(6):372-3. http://www.ncbi.nlm.nih.gov/pubmed/29671534%20?dopt=AbstractPlus

1224. Brett AS. New hypertension guideline is released. From NEJM Journal Watch website. Accessed 2018 Jun 18. https://www.jwatch.org/na45778/2017/12/28/nejm-journal-watch-general-medicine-year-review-2017

1229. Ioannidis JPA. Diagnosis and treatment of hypertension in the 2017 ACC/AHA guidelines and in the real world. JAMA. 2018; 319(2):115-6. http://www.ncbi.nlm.nih.gov/pubmed/29242891?dopt=AbstractPlus

a. AHFS drug information 2017. McEvoy GK, ed. Hydrochlorothiazide. Bethesda, MD: American Society of Health-System Pharmacists; 2017: .

b. AHFS drug information 2017. McEvoy GK, ed. Thiazides general statement. Bethesda, MD: American Society of Health-System Pharmacists; 2017: .

c. AHFS drug information 2017. McEvoy GK, ed. Cardiac glycosides general statement. Bethesda, MD: American Society of Health-System Pharmacists; 2017: .

d. AHFS drug information 2017. McEvoy GK, ed. Captopril. Bethesda, MD: American Society of Health-System Pharmacists; 2017: .

h. American Academy of Pediatrics. The Transfer of Drugs and Other Chemical into Human Milk. Pediatrics. 2001; 108:776-789. http://www.ncbi.nlm.nih.gov/pubmed/11533352?dopt=AbstractPlus

Related questions

Hide