TABLE 1.

Diuretics included as first-line treatments in recommendations

	Essential hypertension	Resistant hypertensiona
National Clinical Guideline Centre (United Kingdom 2011) [2]	Thiazide-like diuretics preferred over thiazide diuretics	Increase dose of thiazide-like diuretic treatment if K >4.5 mmol/l Use low-dose spironolactone if K ≤4.5 mmol/l
National Heart Foundation of Australia (2016) [3]	Thiazides (chlorthalidone, HCTZ, or indapamide)	No instructions to change diuretic treatment Add spironolactone
Hypertension Canada (2016) [4]	Thiazides, but longer acting thiazide-like diuretics preferred	No instructions to change diuretic treatment
Latin American Society of Hypertension (2017) [5]	Thiazide diuretics, indapamide, and chlorthalidone equally recommended	No instructions to change diuretic treatment Use spironolactone and/or an alpha blocker
American College of Cardiology/American Heart Association (2017) [6,7]	Thiazides, but chlorthalidone preferred	Maximize diuretic treatment (substitute HCTZ by indapamide or chlorthalidone) Add a mineralocorticoid receptor antagonist
European Society of Cardiology and the European Society (2018) [8]	Thiazide/thiazide-like diuretics equally recommended	Add low-dose spironolactone Increase dose of thiazide if intolerance to spironolactone

Terminology is defined as follows (not necessarily as defined in guidelines): thiazide, diuretics with a bicyclic benzothiadiazine backbone (such as HCTZ and bendroflumethiazide). Thiazide-like, diuretics that target the early segment of the distal convoluted tubule, but lack the bicyclic benzothiadiazine backbone (such as chlorthalidone, indapamide, and metolazone). Thiazide, thiazide and thiazide-like. HCTZ, hydrochlorothiazide; K, potassium.

^aUncontrolled blood pressure despite the use of three antihypertensive agents of different classes including a diuretic.