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January 19, 1979

Furosemide, Hypertension, and Osteoporosis

Author Affiliations

Gundersen Clinic La Crosse, Wis

JAMA. 1979;241(3):237-238. doi:10.1001/jama.1979.03290290011004

To the Editor.—  The recent study by Araoye et al further confirms the superiority of hydrochlorothiazide over furosemide for treatment of hypertension in patients with satisfactory renal function (240:1863, 1978). Another point to be made in favor of thiazides over the loop diuretics relates to the effect of long-term treatment on urinary calcium excretion. Thiazides conserve calcium; furosemide and ethacrynic acid waste it. Particularly in postmenopausal osteoporotic women with adequate kidneys, the use of furosemide as an antihypertensive is to be decried.The calciuric effect of furosemide is well known in both acute and chronic administration.1 That this calcium excretion may reach a clinically important magnitude is witnessed by the fact that furosemide is used in a standard emergency treatment for hypercalcemic crises (230: 1438, 1974). In contrast, thiazide diuretics given on a long-term basis exert a calcium-retaining effect on the kidney. That this calcium saving may reach a