Guideline Recommendations

Hydrochlorthiazide: An integral part of the Indian Guideline Recommendations for Hypertension Management²

1. First-line Use of HCTZ:
   • 2016 MoHFW and 2019 IGH-IV recommend HCTZ in combination with RAAS inhibitors, or as monotherapy, for most patients. HCTZ is preferred for its effectiveness, affordability, and convenience, particularly in combination therapies.
2. Combination Therapy with HCTZ:
   • Combination therapy is essential when BP is >= 20/10 mmHg above the target.
   • Common combinations include:
     > HCTZ + RAAS inhibitor
     > HCTZ + CCB
3. Stepwise Approach:
   • Both the Indian guidelines support a stepwise approach to treatment. After initial HCTZ + RAAS inhibitor therapy, further drugs such as CCBs or beta-blockers can be added to achieve BP control.
4. HCTZ Dosage & Monitoring:
   • Doses: HCTZ is prescribed at 12.5 mg to 25 mg daily.
   • Monitoring: Monthly BP checks are recommended after initiating or changing therapy.
   • Monitoring should focus on electrolyte imbalances and metabolic effects (e.g., hypokalemia, hyperglycemia)