What is the best diuretic for hypertension?
Thiazide diuretics were the first tolerated efficient antihypertensive drugs that significantly reduced cardiovascular morbidity and mortality in placebo-controlled clinical studies. Although these drugs today still are considered a fundamental therapeutic tool for the treatment of hypertensive pati …
What are the pros and cons of diuretics for hypertension?
Diuretics effectively decrease blood pressure in hypertensive patients, and in adults with hypertension reduce the risk of adverse cardiovascular outcomes. Because of varied pharmacokinetic and pharmacodynamic differences, chlorthalidone may be the preferred thiazide diuretic in the treatment of primary hypertension.
Should patients with gout avoid thiazides for hypertension?
Jan 25, 2022 · Thiazide diuretics are an FDA-approved class of drugs that inhibit reabsorption of 3% to 5% of luminal sodium in the distal convoluted tubule of the nephron. By doing so, thiazide diuretics promote natriuresis and diuresis. Three thiazide diuretics are commonly used: hydrochlorothiazide (HCTZ), chlorthalidone, and indapamide.
What are some examples of thiazide diuretics?
May 26, 2020 · Thiazide diuretics are a common treatment for high blood pressure (hypertension). They are also used to clear fluid from the body in conditions where your body accumulates too much fluid, such as heart failure. (However, a type of diuretic called a loop diuretic is more commonly used to treat heart failure.)
How do diuretics work in 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.
What is the mechanism of action for thiazide diuretics?
Thiazide diuretics increase salt and water excretion primarily by inhibiting mechanisms for electroneutral sodium and chloride transport by distal convoluted tubule cells. This might be termed the 'specific' effect of this class of diuretics and accounts for the 'chlorouretic' effectiveness of the drug.
What is the primary target for thiazide diuretics?
The primary target of hydrochlorothiazide (and other thiazide/thiazide-like diuretics) is the sodium-chloride symporter (SLC12A3, NCC) on the apical membrane of the renal distal tubule. Hydrochlorothiazide is transported from the blood to its site of action by the renal proximal tubule organic acid secretory pathway.
When are thiazide diuretics used?
Thiazide diuretics are used to treat high blood pressure and congestive heart failure as well as the accumulation of fluid and swelling (edema) of the body caused by conditions such as heart failure, cirrhosis, chronic kidney failure, corticosteroid medications, and nephrotic syndrome.
What are the side effects of thiazides?
Common side effects of thiazides are mostly dose-related and involve electrolyte and metabolic abnormalities.
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.
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.
When were thiazide diuretics used?
Thiazide Diuretics have been used since the late fifties in the treatment of hypertension and remain one of the most important group of drugs used to reduce blood pressure, due to their efficacy and cost-effectiveness profile.#N#The use of diuretics (and beta-blockers) to treat hypertension has known a dramatic decline since the early 1980’s through to the early 1990s with the introduction of ACE-inhibitors and calcium channel blockers. Thiazides were used in much higher doses then and concerns were raised regarding their metabolic effects (1). Nevertheless, in this review we will try to demonstrate that thiazide diuretics are still a first line option to treat arterial hypertension.
How long does it take for thiazides to work?
Its half-life of 8 to 12 hours permits effective once daily doses. Among thiazides,
How long does chlorthalidone last?
Its half-life of 8 to 12 hours permits effective once daily doses. Among thiazides, Chlorthalidone is especially long-acting, with an half-life of 50 to 60 hours, and is twice as potent as HCTZ. Initial decreases in blood pressure (BP) are attributed to the reductions in extracellular fluid and plasma volumes.
Is indapamide a diuretic?
At therapeutic dosages indapam ide has only mild diuretic activity and the primary antihypertensive effect is through a direct vasodilatory effect. The efficacy of indapamide in the treatment of hypertension has been examined in large,randomized, multicenter trials with thousands of patients (4-6).
Does thiazide cause hypokalemia?
Safety and Adverse Effects. Thiazides can reduce the excretion of calcium and uric acid and therefore increase their plasma levels. As well, they increase potassium and magnesium excretion, leading to hypokalemia and hypomagnesemia. Hypokalemia seems to be implicated in the pathogenesis of thiazide-induced dysglycemia.
Is ACE inhibitor a diuretic?
On the other hand it has been known, for many years, that when an ACE-inhibitor is added to a thiazide, the metabolic effects of the diuretic are minimized. In all, the cause of diabetes epidemic is increasing overweight/obesity and physical inactivity. Most NOD in diuretic treated patients is not diuretic induced.
Is thiazide a first line diuretic?
However, thiazide diuretics are still a first line option to treat arterial hypertension, due to their efficacy and cost-effectiveness profile. We have presented major trials on this subject in this review. Topic (s): Cardiovascular Pharmacotherapy.
How does thiazide work?
They do this by interfering with the transport of salt and water across certain cells in the kidneys.
What is thiazide used for?
Thiazide diuretics are mainly used to treat high blood pressure (hypertension). They are occasionally also used for heart failure. When used to treat heart failure they are often combined with another type of medicine called a loop diuretic.
What are the side effects of gout?
Common or serious possible side-effects include: 1 A possible increase in your blood sugar level. Some people with diabetes may need more treatment to keep the blood sugar level normal. 2 A possible increase in the level of uric acid. So, if you have gout, you may have more gout attacks. A first attack of gout is sometimes triggered by taking a diuretic. 3 The salt balance in the bloodstream is sometimes upset which can cause a low blood level of potassium, sodium and magnesium, and a high level of calcium. These effects may cause weakness, confusion and, rarely, abnormal heart rhythms to develop. You may be advised to have a blood test to check for these problems. 4 Other problems, such as: 5 Upset stomach. 6 Dizziness on standing - due to too low blood pressure (hypotension). 7 Erection problems (impotence) - often reversible on stopping treatment. 8 Skin sensitivity to sunlight.
What is a water tablet?
A diuretic is a medicine which increases the amount of water that you pass out from your kidneys. (A diuretic causes an increase in urine, called a diuresis.) So, they are sometimes called 'water tablets'. There are different types of diuretics which work in different ways and thiazide diuretics are one type of diuretic.
How often should I take thiazide?
Most thiazide diuretics are taken once a day in the morning. Any reduction in blood pressure is maintained throughout the 24 hours by this once-a-day dose. However, the effect of passing extra urine wears off within 12 hours. So, you will not have to get up in the night to make extra trips to the toilet. Indeed, the dose used to treat high blood ...
What is a loop diuretic?
They are also used to clear fluid from the body in conditions where your body accumulates too much fluid, such as heart failure. (However, a type of diuretic called a loop diuretic is more commonly used to treat heart failure.)
What happens if you have a low potassium level?
These effects may cause weakness, confusion and, rarely, abnormal heart rhythms to develop. You may be advised to have a blood test to check for these problems.
How does thiazide diuretics work?
Thiazide diuretics act on the distal tubule of the nephron by inhibiting sodium reabsorption. With this inhibition, more sodium stays within the nephron creating an osmotic force that allows for water retention in the nephron, and ultimately water excretion.
How do diuretics help with blood pressure?
Diuretics help rid your body of sodium and water. Most work by making your kidneys release more sodium into the urine. The sodium then takes water with it from your blood decreasing the amount of fluid flowing through your blood vessels hence lowering blood pressure.
Why are diuretics prescribed?
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.
How long does a loop diuretic last?
On the other hand, loop diuretics are known to be less effective than thiazides, and have a short duration of action at approximately 6 hours. Loop diuretics are indicated for patients with coexistent renal or heart failure, in circumstances when thiazide diuretics are rarely effective.
Does sodium lower blood pressure?
The sodium then takes water with it from your blood decreasing the amount of fluid flowing through your blood vessels hence lowering blood pressure . Diuretics are used effectively in the management of hypertension, and are typically prescribed because of their efficacy, low cost, and low side effects profile.
How many people in the US have hypertension?
In the USA, approximately one in three adults suffers from hypertension [1]. The lifetime risk for developing hypertension is very high, estimated at almost 90% in those who live to 80–85 years of age [2]. Hypertension is a known risk factor for both heart disease and stroke.
Does insulin increase potassium?
Insulin can cause increased cellular uptake of potassium, which is an important mechanism of potassium disposal [60,61]. However, smaller increases in potassium (<1 mEq/l) do not appear to induce this insulin-secreting effect [61,62].
Do thiazides lower blood pressure?
Despite the widespread use of this drug class, the mechanism by which thiazide diuretics lower blood pressure remains poorly understood. In addition, while many agree that thiazides adversely affect glucose and lipid homeostasis, only hypotheses currently exist as to why and how these metabolic effects occur.
Is thiazide a diuretic?
Abstract. Thiazide and thiazide-like diuretics are among the most commonly used antihypertensives and have been available for over 50 years. However, the mechanism by which these drugs chronically lower blood pressure is poorly understood.
What is the purpose of diuretics?
By Mayo Clinic Staff. Diuretics, sometimes called water pills, help rid your body of salt (sodium) and water. Most of them help your kidneys release more sodium into your urine. The sodium takes with it water from your blood, decreasing the amount of fluid flowing through your veins and arteries. This reduces blood pressure.
Can thiazide be used for high blood pressure?
When diuretics are used. Thiazide diuretics are recommended as one of the first drug treatments for high blood pressure. If diuretics aren't enough to lower your blood pressure, your doctor might add other blood pressure medications to your treatment plan.
How does thiazide diuretics work?
Thiazide diuretics work by blocking sodium and chloride (Na/Cl) channels in the distal convoluted tubule of the nephron and inhibit the reabsorption of sodium and water. This also causes a loss of potassium and calcium ions.
What are the side effects of thiazide?
Rare but serious side effects of thiazide diuretics may include: Pancreatic toxicity (abnormality in the function of the pancreas caused by the toxic nature of the drug) Acute pancreatitis ( inflammation of the pancreas) Increase pancreatic secretions.
What is the purpose of water pills?
Diuretics are drugs that work on the kidneys to remove electrolytes such as sodium and chloride from the body in the urine. These electrolytes draw water along with them; thus, excess water also gets eliminated in the urine.
What are the symptoms of hypercalcemia?
Hypercalcemia (increase in calcium levels in the blood) Hyperglycemia (increase in sugar levels in the blood) Hyperuricemia (increase in potassium levels in the blood) Hyperlipidemia (increased fats in the blood) Sexual dysfunction. Dizziness. Blurred vision. Loss of appetite. Stomach discomfort.
What is the best medication for high blood pressure?
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.
Does thiazide increase uric acid?
Thiazides reduced potassium, increased uric acid and increased total cholesterol and triglycerides. These effects were dose-related and were least for hydrochlorothiazide. Chlorthalidone increased serum glucose but the evidence was unclear for other thiazides. There is a high risk of bias in the metabolic data.
Do thiazides lower blood pressure?
Although it is established that low-dose thiazides reduce mortality as well as cardiovascular morbidity, the dose-related effect of thiazides in decreasing blood pressure has not been subject to a rigorous systematic review.
Does hydrochlorothiazide lower blood pressure?
This systematic review shows that hydrochlorothiazide has a dose-related blood pressure-lowering effect. The mean blood pressure-lowering effect over the dose range 6.25 mg, 12.5 mg, 25 mg and 50 mg/day is 4/2 mmHg, 6/3 mmHg, 8/3 mmHg and 11/5 mmHg, respectively. For other thiazide drugs, the lowest doses studied lowered blood pressure maximally and higher doses did not lower it more. Due to the greater effect on systolic than on diastolic blood pressure, thiazides lower pulse pressure by 4 mmHg to 6 mmHg. This exceeds the mean 3 mmHg pulse pressure reduction achieved by ACE inhibitors, ARBs and renin inhibitors, and the 2 mmHg pulse pressure reduction with non-selective beta-blockers as shown in other Cochrane reviews, which compared these antihypertensive drug classes with placebo and used similar inclusion/exclusion criteria.
Background
- Thiazide Diuretics have been used since the late fifties in the treatment of hypertension and remain one of the most important group of drugs used to reduce blood pressure, due to their efficacy and cost-effectiveness profile. The use of diuretics (and beta-blockers) to treat hypertension has known a dramatic decline since the early 1980’s through ...
Clinical Pharmacology
- The onset of action occurs after 2 to 3 hours for most thiazides, with little natriuretic effect occuring beyond 6 hours (2). The bioavailability and plasma half-lives explain the differences in pharmacokinetics of different compounds, and hydrochlorothiazide (HCTZ), which has the best profile, was elected as the paradigm of thiazides for the treatment of hypertension. Its half-life o…
Safety and Adverse Effects
- Thiazides can reduce the excretion of calcium and uric acid and therefore increase their plasma levels. As well, they increase potassium and magnesium excretion, leading to hypokalemia and hypomagnesemia. Hypokalemia seems to be implicated in the pathogenesis of thiazide-induced dysglycemia. We will come to this topic later in this paper. New onset diabetes has been reporte…
Chlorthalidone Superior to Hydrochlorothiazide
- Most major clinical trials used either HCTZ or chlorthalidone. The trial sponsored by the National Heart, Lung and Blood Institute (ALLHAT) used chlorthalidone on the belief that it might have advantages related to its longer duration of action. In addition, the data from Multiple Risk Factor Intervention Trial (MRFIT) suggested that chlorthalidone could confer mortality benefits over HC…
Main Clinical Trials
- There is a consensus that large randomized trials measuring fatal and non-fatal events represent the strongest type of evidence available (11) ALLHAT was designed to address the issue of which class of drugs should be the first –step therapy for hypertension. In the early 90s, that was a very timely question due to the recent introduction of new groups of drugs for hypertension. The over…
New Onset Diabetes and Hypokalemia with Thiazides
- Recent epidemic of obesity and diabetes raised again the problem of adverse effect of thiazides, namely the metabolic effects. In the ALLHAT, among the patients without diabetes mellitus (DM) at baseline, the percentage of incident DM was 11% in the chlorthalidone group, 9.3% in the amlodipine group and 7.8% in the lisinopril group, respectively. In spite of that higher incidence o…
Accomplish Trial
- In the ACCOMPLISH trial (19) (Avoiding CV events through combination therapy in patients living with systolic hypertension) 11,506 patients with hypertension who were at high risk for CV events, were randomised to receive treatment with either benazepril plus amlodipine or benazepril plus HCTZ. The hypothesis to test was if the association of a ACE-inhibitor plus a CCB would be bett…