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August 11, 1999

Diuretics for Hypertension

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;282(6):523-525. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-6-jbk0811

To the Editor: Dr Moser1 appropriately indicates the benefits and low cost of diuretics, but he does not address what I have found to be the most obvious reason for underprescribing diuretics: patients simply do not like to take diuretics because of the attendant inconvenience.

Although I was taught in medical school that after several days the diuretic effect is diminished and the antihypertensive effect continues, this is not the experience of many patients who take diuretics. Patients have to schedule appointments around the use diuretics. Women with stress incontinence and men with prostatism are particularly troubled by lack of bladder control. In discussing antihypertensive treatment with my patients who had used diuretics in the past, I have found that they often refuse to resume diuretics even though the drugs effectively controlled blood pressure. When patients demur taking a class of medications, physicians can only respond by choosing other agents.

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