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Thiazide diuretics (e.g. bendrofluazide, hydrochlorothiazide) are generally used as a first-line treatment in the elderly, or are combined with other anti-hypertensive drugs (e.g. a beta-blocker or ACE inhibitor) to boost their action in younger patients.

They lower blood pressure by increasing loss of salts through the kidneys into the urine. This tends to draw fluid out of the circulation, causes mild dilation of small arteries and lowers arteriolar resistance. The diuretics act within an hour or two of being given and are usually taken in the morning so you do not have to get up at night to pass water. When you first start taking the tablets, you may notice that you have to pass water more frequently than usual for the first few days;, then this effect tends to disappear as dilation of the arterioles occurs. Only low doses of hiazide diuretic are needed to bring your diastolic BP down by around 5 mmHg – higher doses have no further effect on BP and are more likely to cause side effects such as salt imbalances.

They should not be used by people with diabetes or with sodium, potassium or calcium imbalances, severe kidney or liver problems, active gout or Addison’s disease.