Summary of evidence and Expert Committee recommendations
Hydrochlorothiazide oral liquid (50 mg/5 mL) was added to the core list of the EML for use in the treatment of heart failure.
An application for hydrochlorothiazide (new formulations) was commissioned by the Secretariat as part of a review of the section on medicines used in heart failure. It was prepared by the NHS Centre for the Evaluation of Effectiveness of Health Care (CeVEAS), Local Health Unit, Modena, Italy. Comments on the application were received from MSF.
The Committee noted the one Cochrane Review (1) (n = 202) cited showed that thiazides are useful in the relief of symptoms, reduce episodes of de-compensation, and improve exercise tolerance, but do not affect the outcome of heart failure. It also noted evidence of relative efficacy of thiazides in hypertension when compared to beta-blockers (2).
The Committee noted that although thiazides have various potentially serious side-effects, they are relatively safe at doses below 25 mg/day and that their antihypertensive effect has largely been achieved at this dose (3).
The Committee noted that the application did not present any evidence for the safety or efficacy of thiazides in children and therefore was not able to recommend its addition to the EMLc but requested a further review of paediatric evidence for use of thiazides for hypertension.
1. Faris R et al. Diuretics for heart failure. Cochrane Database of Systematic Reviews, 2006, CD003838.
2. Wiysonge CS et al. Beta-blockers for hypertension. Cochrane Database of Systematic Reviews, 2007, (1):CD002003.
3. Sica DA. Diuretic-related side effects: development and treatment. Journal of Clinical Hypertension, 2004, 6:532–540.