Which diuretic is most frequently used for mild hypertension?

Which diuretic is most frequently used for mild hypertension?

• A. Hydrochlorothiazide
• B. Furosemide
• C. Spironolactone
• D. Acetazolamide

Answer: (A)

The key idea is that for mild, uncomplicated hypertension, a thiazide-type diuretic is the go-to first-line option. Hydrochlorothiazide works by blocking the Na-Cl cotransporter in the distal convoluted tubule, producing a gentle diuresis. Over time this reduces plasma volume and, more importantly, lowers peripheral vascular resistance, leading to sustained blood pressure reductions. Thiazides are effective for mild hypertension, inexpensive, and generally well tolerated, making them a common initial choice. Loop diuretics like furosemide are far more potent and are typically reserved for edema, heart failure, or renal impairment situations; they cause more electrolyte disturbances. Spironolactone is a potassium-sparing diuretic useful in resistant hypertension or hyperaldosteronism but carries a higher risk of hyperkalemia, so it’s not first-line for mild cases. Acetazolamide is a carbonic anhydrase inhibitor with limited use in hypertension and more commonly used for other indications, not primary blood pressure control. So hydrochlorothiazide is the best answer for mild hypertension.

The key idea is that for mild, uncomplicated hypertension, a thiazide-type diuretic is the go-to first-line option. Hydrochlorothiazide works by blocking the Na-Cl cotransporter in the distal convoluted tubule, producing a gentle diuresis. Over time this reduces plasma volume and, more importantly, lowers peripheral vascular resistance, leading to sustained blood pressure reductions. Thiazides are effective for mild hypertension, inexpensive, and generally well tolerated, making them a common initial choice.

Loop diuretics like furosemide are far more potent and are typically reserved for edema, heart failure, or renal impairment situations; they cause more electrolyte disturbances. Spironolactone is a potassium-sparing diuretic useful in resistant hypertension or hyperaldosteronism but carries a higher risk of hyperkalemia, so it’s not first-line for mild cases. Acetazolamide is a carbonic anhydrase inhibitor with limited use in hypertension and more commonly used for other indications, not primary blood pressure control.

So hydrochlorothiazide is the best answer for mild hypertension.