Do diuretics have antihypertensive properties independent of natriuresis?

Clin Pharmacol Ther. 1977 Nov;22(5 Pt 1):499-504.


To ascertain whether diuretics have an antihypertensive effect independent of natriuresis, 12 stable patients on maintenance hemodialysis underwent a crossover evaluation with hydrochlorothiazide, 50 mg daily, metolazone, 5 mg daily, or placebo in 4-wk treatment periods for 6 mo. Compliance was assured by pill counts and serum drug concentrations. All patients had daily urine less than 100 ml. Pre- and postdialysis blood pressure, body weight, plasma volume, and plasma renin activity were monitored. Over the 6-mo study period there were no statistically significant changes in any parameter related to diuretic therapy. It is concluded that a functioning kidney with the ability to respond to diuretics with a natriuresis is necessary for the antihypertensive action of diuretics. Direct vascular effects of diuretics to lower peripheral resistance could not be demonstrated in this unique patient population.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Antihypertensive Agents*
  • Blood Pressure / drug effects
  • Clinical Trials as Topic
  • Diuretics / pharmacology*
  • Double-Blind Method
  • Humans
  • Hydrochlorothiazide / pharmacology
  • Kidney Failure, Chronic / physiopathology
  • Male
  • Metolazone / pharmacology
  • Middle Aged
  • Natriuresis*
  • Placebos
  • Renal Dialysis


  • Antihypertensive Agents
  • Diuretics
  • Placebos
  • Hydrochlorothiazide
  • Metolazone