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High Blood Pressure

HCTZ greater than 12.5



does hydrochlorothiazide greater than 12.5 but not more than 25 cause more side effects which is harmful to metabolism ?


Increasing the dose of hydrochlorothiazide from 12.5 mg to 25 mg per day causes a slight increase in metabolic side effects.

Metabolic side effects include hyponatremia (low sodium level), hypokalemia (low potassium level), increase in uric acid level and an increase in calcium level.  These risks are small.

There may also be an increased risk in developing diabetes and possibly an increase in LDL cholesterol level.  However, these side effects are controversial and their risk is even smaller than for the above mentioned electrolyte side effects.

In summary, thiazide diuretics like hydrochlorothiazide are very safe, especially at low doses (25 mg per day or less).  There is very little risk of side effects, while the benefit from lowering blood pressure is significant.

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Response by:

Max C Reif, MD Max C Reif, MD
Professor of Medicine
Director of Hypertension Section
College of Medicine
University of Cincinnati