Diuretics for Hypertension

To the Editor: Dr Moser¹ addresses a very important problem of financial and therapeutic medical decision making. The unjustified decrease in use of diuretics and the preference of much more expansive, newer antihypertensives in the United States represent a significant problem both medically and economically.²

Surprisingly, the same trend is present in one of the newly emerged Eastern European market economies. In Hungary, the use of diuretics decreased about as rapidly as it did in the United States. In 1983, Hungarian physicians prescribed a diuretic in 40.42% of all cases for which they prescribed an antihypertensive. This percentage decreased to 15.81% in 1997.³ Interestingly, no similar trend was seen in the other leading Eastern European democracy, the Czech Republic. Diuretics precribed by physicians in that country represented 35.2% of all antihypertensives prescribed in 1996⁴ (Figure 1).