Diuretics are used effectively in the management of hypertension, and are typically prescribed because of their efficacy, low cost, and low side effects profile. Diuretics are known for their ability to increase the formation and excretion of urine.
What is the best diuretic for high blood pressure?
Diuretics have long been used for the treatment of hypertension. Thiazide diuretics are the most commonly prescribed diuretics for hypertension, but other classes of diuretics may be useful in alternative circumstances. Although diuretics are no longer considered the preferred agent for treatment of …
Are loop diuretics effective for hypertension?
Diuretics in the treatment of hypertension. Part 2: loop diuretics and potassium-sparing agents Loop diuretics are less effective than thiazide diuretics in lowering blood pressure, so that their major use is in edematous patients with congestive heart failure (HF), cirrhosis with ascites and nephritic edema.
What are the side effects of diuretics for hypertension?
Other types of diuretics (e.g., loop, potassium sparing) may be useful for the treatment of hypertension related to chronic kidney disease (CKD) and other varied conditions. Common side effects of thiazides are mostly dose-related and involve electrolyte and metabolic abnormalities.
What are diuretics used for?
Diuretics, sometimes called water pills, treat a variety of conditions, such as high blood pressure, glaucoma and edema. Find out more about this class of medication. Diuretics, sometimes called water pills, help rid your body of salt (sodium) and water. Most work by making your kidneys release more sodium into your urine.
Why are diuretics used for edema?
Other conditions are also treated with diuretics. Congestive heart failure, for instance, keeps your heart from pumping blood effectively throughout your body. This leads to a buildup of fluids in your body, which is called edema. Diuretics can help reduce this fluid buildup.
Why are diuretics used to treat patients with hypertension?
Diuretics, sometimes called water pills, help rid your body of salt (sodium) and water. Most of these medicines help your kidneys release more sodium into your urine. The sodium helps remove water from your blood, decreasing the amount of fluid flowing through your veins and arteries. This reduces blood pressure.
Is diuretic drugs are used in treatment of edema?
Loop diuretics Some examples of the conditions these agents are used to treat include: Acute pulmonary edema. Acute left ventricular failure or heart failure. Most types of edema or fluid accumulation.
Why are diuretics first line for hypertension?
First-line treatment of hypertension with thiazide diuretics has been shown to significantly reduce serious cardiovascular morbidity (stroke and myocardial infarction [MI]) and mortality in randomised controlled trials, with benefits at least as great as first-line treatment with other classes of antihypertensive drug ...
When is diuretic used for hypertension?
Diuretics are useful antihypertensive agents, and there is compelling evidence for their efficacy in patients with heart failure, elderly patients, patients with isolated systolic hypertension, and black patients. Low dose thiazide diuretics are the most cost effective agents in mild to moderate hypertension.
What do diuretics treat?
What are diuretics used for? Diuretics help your body dispose of extra fluid and salt. They also treat a variety of medical problems, such as heart failure and high blood pressure.
Why are diuretics used intraoperatively?
We hypothesize that intraoperative diuretic therapy can improve the hemodynamic and clinical outcome in patients undergoing mitral valve surgery by decreasing TFC as measured by impedance cardiography (ICG).
Why are diuretics given in a clinical setting?
Diuretics are commonly used to control edema across various clinical fields. Diuretics inhibit sodium reabsorption in specific renal tubules, resulting in increased urinary sodium and water excretion.
How do diuretics work pharmacology?
Diuretics act primarily by blocking reabsorption of sodium at four major sites in the nephron. Clinically useful agents that block sodium reabsorption effectively in the proximal tubule are lacking.
When are diuretics used?
Your doctor may recommend a diuretic if you have:Edema. Diuretics lessen swelling that usually happens in the legs.High blood pressure. Thiazide diuretics lower blood pressure. ... Heart failure. Diuretics ease swelling and congestion in the lungs. ... Kidney problems. You'll keep less water.Liver problems. ... Glaucoma.
Are diuretics effective in lowering blood pressure?
Diuretics are a good first-line treatment for high blood pressure (BP). Diuretics include loop diuretics and thiazides. We asked how much do diuretics reduce BP when used as the second drug to treat hypertension.
Why are thiazide diuretics used for hypertension?
Thiazide diuretics are a class of drugs commonly recommended as first-line treatment for raised blood pressure because they significantly reduce death, stroke and heart attacks. This class includes bendrofluazide, chlorthalidone, cyclopenthiazide, hydrochlorothiazide, indapamide and metolazone.
What is the best diuretic to control blood pressure?
One of the most commonly prescribed thiazide-like diuretics is chlorthalidone. Studies show that it may be the best diuretic to control blood pressure and prevent death. Indapamide is another thiazide-like diuretic.
How does diuretic affect the kidneys?
Each of the three types of diuretic medication increases the amount of sodium you excrete through urination, but they affect different areas of your kidneys. Your kidneys are the filters through which toxins and excess fluids are flushed from your body.
What are some examples of thiazides?
Examples of thiazides include metolazone (Zaroxolyn), indapamide (Lozol), and hydrochlorothiazide (Microzide).
What foods can help with hypertension?
dark leafy greens, such as kale and spinach. squash. mushrooms. potatoes. yogurt. fish. Potassium-sparing diuretics don’t pose as much as a threat to your potassium levels. However, they aren’t as effective in treating hypertension as the other types of diuretic medications, so they are often prescribed along with other drugs.
How do loop diuretics work?
Loop diuretics remove excess fluid by causing the kidneys to produce more urine.
What causes swelling in the joints of the foot?
increased thirst. irregular menstruation. impotence, or. difficulty achieving and maintaining an erection. gout, or conditions that cause swelling and pain in the joints of the foot. Side effects are likely to decrease over time.
Can diuretics help with high blood pressure?
High blood pressure can be a contributing factor in the development of various forms of heart disease. When chosen as a treatment for hypertension, diuretics have proven to be effective in preventing heart attack and stroke in many individuals.
Which diuretics should be used for hypertension?
The Seventh Report of the Joint National Committee (JNC VII) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends that thiazide diuretics should be preferred drugs in “most” hypertensive patients, either alone or combined with drugs from other classes (2).
Which study failed to demonstrate the superiority of diuretics over comparators?
Another major study that failed to demonstrate the superiority of diuretics over comparators was the ANBP2 trial . This was a randomized open-label study between diuretics and ACE inhibitors conducted in 6,083 elderly subjects with hypertension. The ACE inhibitor enalapril and the diuretic hydrochlorothiazide were recommended as initial therapy, but the final choice of the specific agent was left to investigators, who were family practitioners. The primary end point of the study, a composite of CV morbidity and all-cause mortality, was marginally less frequent in the ACE inhibitor group than in the diuretic group (hazard ratio [HR] 0.89, 95% CI 0.79–1.00; P= 0.05) (10).
Does hydrochlorothiazide help with hip fractures?
(24) showed that hydrochlorothiazide slowed cortical bone loss in normal postmenopausal women. Schoofs et al. (23) showed in a prospective population-based cohort study that thiazide protects against hip fra ctures and that this protective effect disappears within 4 months after use is discontinued. Thus, in addition to their use to lower BP, thiazide plays a major role in the prevention of osteoporosis and fractures.
Does indapamide reduce stroke risk?
In the era of placebo-controlled trials, several studies attested to the efficacy of diuretics in reducing stroke morbidity and mortality (6,7). In a recent published study from China, indapamide given to patients with a history of stroke or transient ischemic attack reduced the risk of stroke by 31% (3). In the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) (9) in patients with cerebrovascular disease, combination therapy of a diuretic (indapamide) and ACE inhibitor (perindopril) reduced the risk of stroke by 43% compared with placebo. Perindopril alone, despite lowering systolic BP by 5 mmHg, decreased stroke risk only by a nonsignificant 5%.
Does thiazide affect glucose?
Several studies showed that use of thiazide diuretic increases glucose levels (4,12,26), but in these studies, the second drug was a β-blocker that impaired glucose metabolism. The Atherosclerosis Risk in Communities (ARIC) study assessed the incidence of new-onset diabetes (NOD) after 3 and 6 years in 12,550 adults who did not have diabetes. Patients who received thiazide diuretics were not at greater risk for the subsequent development of diabetes than the subjects with hypertension who were not receiving any antihypertensive therapy (27). In this study, only subjects with hypertension who were taking β-blockers had a 28% higher risk of subsequent diabetes. In the ACCOMPLISH study, the effects of the two treatment arms on glucose levels were not reported (15). It is likely that the use of diuretics with an ACE inhibitor did not adversely affect glucose metabolism, as we have previously shown (28). If a high-dose diuretic has a negative effect on glucose metabolism, it may be related to hypokalemia (29–31). Analysis of the SHEP data showed that each 0.5 mEq/L decrease in serum potassium during the 1st year of treatment was associated with a 45% higher adjusted diabetes risk (32). Potassium supplementation or combination of thiazide with ACE inhibitor or potassium-sparing agents might prevent thiazide-induced diabetes (33). The combination of thiazide with aldosterone antagonist may not only prevent NOD but also improve BP control (34). It seems that not all diuretics are equal in regard to the effect on insulin resistance. Leonetti et al. (35) showed that indapamide does not have a deleterious effect on glucose tolerance. The effects of diuretic-induced glucose elevation on long-term CV risk were reported in several studies. Verdecchia et al. (36) reported a nearly threefold higher CV disease risk after 16 years of follow-up in treated patients with hypertension (54% treated with diuretics) who developed NOD; no relationship was seen between diuretic usage and CV events. In post hoc subgroup analyses of the ALLHAT data, there was no significant association of fasting glucose level change at 2 years with subsequent coronary heart disease, stroke, CV disease, total mortality, or end-stage renal disease. There was no significant association of incident diabetes at 2 years with clinical outcomes, except for coronary heart disease (risk ratio 1.64; P= 0.006), but the risk ratio was lower and nonsignificant in the chlorthalidone group (risk ratio 1.46; P= 0.14) (37). Analysis of the 14.3 years of follow-up from the SHEP revealed that incident diabetes during the trial among participants randomized to placebo was associated with a >50% increase in CV mortality but not in individuals randomized to the diuretic (38). Thus, diuretic-induced glucose changes may underline lesser prognostic significance.
Does diuretic therapy reduce stroke risk?
In a large meta-analysis, including 48,220 patients, Psaty et al. (13) found that high-dose diuretic therapy reduced the risk of stroke by 51% , whereas therapy with β-blockers reduced the risk by only 29% (P= 0.02). Klungel et al. (14) showed that among 1,237 single-drug users with no history of CV disease, the adjusted risk of ischemic stroke was 2 to 2 1/2 times higher among users of β-blockers, calcium antagonists, or ACE inhibitors than among users of a diuretic alone. Interestingly, even in patients with CV disease, diuretics still conferred a lower stroke risk than other drugs, although the difference was considerably smaller. The recent Avoiding Cardiovascular Events Through Combination Therapy in Patients Living With Systolic Hypertension (ACCOMPLISH) trial showed that a combination of the ACE inhibitor benazepril with hydrochlorothiazide was less effective in lowering the risk of the predefined primary end points than the combination of benazepril with amlodipine (15). However, analysis of the benefit for the individual components of the primary end points showed that, for stroke prevention, hydrochlorothiazide and amlodipine were the same. Thus, for stroke prevention, a diuretic is superior to some antihypertensive agents.
Is thiazide a diuretic?
Although thiazide and thiazide-like diuretics are indispensable drugs in the treatment of hypertension, their role as first-line or even second-line drugs is a provoking debate.
What is the most commonly prescribed diuretic for hypertension?
Diuretics have long been used for the treatment of hypertension. Thiazide diuretics are the most commonly prescribed diuretics for hypertension, but other classes of diuretics may be useful in alternative circumstances.
What are the side effects of thiazides?
Common side effects of thiazides are mostly dose-related and involve electrolyte and metabolic abnormalities.
Can diuretics be used for hypertension?
Although diuretics are no longer considered the preferred agent for treatment of hypertension in adults and children, they remain acceptable first-line options. Diuretics effectively decrease blood pressure in hypertensive patients, and in adults with hypertension reduce the risk of adverse cardiovascular outcomes.
Why are diuretics important?
Diuretics increase the effectiveness of all other categories of antihypertensives. That is why they are an essential part of almost any multidrug regimen for hypertension. Special Points: Diuretics are the original antihypertensives. Therefore, their efficacy and adverse effects are very well understood.
What are the different types of diuretics?
Different Drugs: Thiazide diuretics include: hydrochlorothiazide (usual starting dose 12.5 to 25 mg daily) or chlorthalidone (similar dose range). Loop diuretics include: furosemide (Lasix), bumetanide (Bumex), and torsemide (Demadex), torsemide has a rather longer duration and is preferred in patients with heart failure. Ethacrinic acid (Edecrin) is used in the rare patients who are allergic to diuretics. Loop diuretics are not as effective as thiazides in lowering blood pressure in patients with hypertension. They are used especially to treat edema (swelling of the ankles) or heart failure. However, unlike thiazides, they effective in patients with poor kidney function in lowering blood pressure or treating edema.
What is the best medication for hypertension?
Diuretics. There are three classes of diuretic drugs that are used to treat hypertension. Most commonly used are thiazide diuretics such as hydrochlorothiazide or chlorthalidone. There is not usually an increased urine flow after the first one or two days of taking these medications. Nevertheless, it is best to take them in ...
What is edecrin used for?
Ethacrinic acid (Edecrin) is used in the rare patients who are allergic to diuretics. Loop diuretics are not as effective as thiazides in lowering blood pressure in patients with hypertension. They are used especially to treat edema (swelling of the ankles) or heart failure.
Why are ACEIs used for hypertension?
ACEIs are widely used to treat hypertension because they are effective, have relatively few side effects and in reduce the complications of hypertension such as heart attacks and strokes. They have a special use in patients with diabetes mellitus who have protein the urine (“diabetic nephropathy”) and in patients with chronic kidney disease (CKD) in whom they appeared to have beneficial actions in slowing the loss of kidney function above that achieved by other agents.
Is thiazide a first line drug?
For this reason, the Joint National Commission on Hypertension Detection Evaluation and Treatment (JNCVII) recommended thiazide diuretics as first line therapy for patients with hypertension, unless there were special reasons to select another type of drug.
How often do you give captopril?
There are some small differences in how long these drugs act in the circulation, they are relatively small and, with the exception of the very short acting captopril, any of these agents are usually affective when given once or sometimes twice daily as antihypertensive agents.