This study is a meta-analyses of RCTs in hypertension using thiazide diuretics and thiazide-potassium sparing(ENaC-Inhibitor) combination drugs were conducted. The findings:

Significant reductions in both coronary mortality and SCD were observed in the overview of trials in which elderly patients received an ENaC inhibitor/HCTZ combination. The odds ratio (OR) for coronary mortality was 0.59 (95% confidence

interval [CI], 0.44 to 0.78) and for SCD was 0.60 (95% CI, 0.38 to 0.94). In contrast, an overview of the trials using thiazide diuretics alone showed no significant reductions of either coronary mortality (OR, 0.94; 95% CI, 0.81 to 1.09) or SCD (OR, 1.27; 95% CI, 0.93 to 1.75).

Use of an ENaC inhibitor combined with HCTZ for treatment of hypertension in the elderly results in favorable effects on coronary mortality and SCD.

ALLHAT study was first to show that Diuretics are the first choice hypertensive drug especially in elderly. Diuretics are cheap and works well.Current US guidelines recommend using diuretics as initial choice.But Diuretics usage is associated with elecrolyte abnormalities that can be dangerous. This paper discusses this issue clearly. This is an old editorial that is titled Does Thiazides Kill? Will the guidelines change after this study? You want to read what the author of this study had to say in this report? Read more.