Cardiovascular disease remains the number one killer of women in the United States. Hypertension is considered a major cardiovascular risk factor, but remains poorly controlled in women. Thiazide diuretics are recommended as first line treatment in women with hypertension based on numerous outcomes studies demonstrating decreased risk of cardiovascular events. However, despite definitive evidence demonstrating clinical benefits and generic availability, diuretic-based therapy is underutilized. This article will focus on the role of thiazide diuretics for hypertension, discuss the mechanism by which diuretics lower blood pressure, describe outcomes studies that support their use in women, and provide practical considerations for use and monitoring.