A pilot study comparing furosemide and hydrochlorothiazide in patients with hypertension and stage 4 or 5 chronic kidney disease

J Clin Hypertens (Greenwich). 2012 Jan;14(1):32-7. doi: 10.1111/j.1751-7176.2011.00564.x. Epub 2011 Dec 9.


Furosemide is the diuretic of choice for the treatment of hypertension in chronic kidney disease but the adaptative changes in the distal nephron may decrease its efficacy. Hydrochlorothiazide is not believed to be efficient in this setting. In a randomized, double-blind, cross-over trial, 23 patients with hypertension and stage 4 or 5 chronic kidney disease received long-acting furosemide (60 mg) and hydrochlorothiazide (25 mg) for 3 months and then both diuretics for 3 months. Sodium and chloride fractional excretions were measured after 3 months of each diuretic and then after their association. A trend towards an increase in the fractional excretion of sodium and chloride was observed with furosemide and hydrochlorothiazide (P=not significant). The association of the two diuretics increased the fractional excretions of sodium and chloride from 3.4±1.8 to 4.9±2.8 and from 3.8±2.0 to 6.0±3.1, respectively (P<.05). Furosemide and hydrochlorothiazide decreased mean blood pressure by the same extent. The association of the two diuretics was more efficient on blood pressure. There were no differences between furosemide and hydrochlorothiazide with respect to natriuresis and blood pressure control in patients with hypertension and chronic kidney disease.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anthropology / methods
  • Biological Availability
  • Blood Pressure / drug effects*
  • Chronic Disease
  • Diet Records
  • Diuretics / administration & dosage
  • Diuretics / pharmacokinetics
  • Double-Blind Method
  • Drug Therapy, Combination
  • Female
  • Furosemide* / administration & dosage
  • Furosemide* / pharmacokinetics
  • Humans
  • Hydrochlorothiazide* / administration & dosage
  • Hydrochlorothiazide* / pharmacokinetics
  • Hypertension* / complications
  • Hypertension* / drug therapy
  • Hypertension* / physiopathology
  • Kidney Diseases* / complications
  • Kidney Diseases* / drug therapy
  • Kidney Diseases* / physiopathology
  • Kidney Function Tests
  • Male
  • Middle Aged
  • Natriuresis / drug effects*
  • Pilot Projects
  • Severity of Illness Index
  • Treatment Outcome
  • Water-Electrolyte Balance / drug effects


  • Diuretics
  • Hydrochlorothiazide
  • Furosemide