METABOLIC EFFECTS OF DIURETICS

Hypokalaemia, hyperuricaemia, hypomagnesaemia and alterations to lipid and glucose metabolism undoubtedly occur with loop and thiazide diure tic treatment. Many of the metabolic effects induced by thiazide diure tics, however, can be limited by the use of low doses. Apart from prec ipitation of gout and worsening control of diabetes the clinical impor tance of these changes is slight. In hypertensive patients treated wit h diuretics, long-term outcome trials have shown significant benefit i n terms of reduction in stroke and coronary events. Diuretics should t herefore remain first-line treatment for all patients with heart failu re, and in patients with hypertension except those with diabetes or go ut.