It has been suggested by researchers that the diuretic clorthalidone should be the first line of antihypertensive therapy with a few caveats. Firstly in the presence of certain co-morbidities other drugs with a proven track record of reducing end organ damage should be instituted as first line instead. Thus it has been suggested that in patients with diabetic kidney disease and angiotensin receptor blocker (ARB) be commenced early due to its proven reno-protective effects in type 2 diabetics with kidney disease.
The results of the ACCOMPLISH trial as reported in the LANCET may change the above approach.
