Thiazide diuretics are particularly effective in preventing stroke and hf in hypertensive patients. Use of diuretics in patients with hypertension new england journal. Diuretics are critical in the management of resistant hypertension. The clinical use of diuretics in conditions like congestive cardiac failure and hypertension, as well as some rarer, but clinically important, conditions is then examined. Pdf diuretic treatment of hypertension researchgate. Apr 22, 2011 although thiazide and thiazidelike diuretics are indispensable drugs in the treatment of hypertension, their role as firstline or even secondline drugs is a provoking debate. Thiazide diuretics are the oldest class of antihypertensive drugs still in use. Apr 18, 2020 diuretics, thiazidethiazide diuretics are used as monotherapy, or they can be administered adjunctively with other antihypertensive agents. Role of diuretics in treatment of essential hypertension american. Role of diuretics in treatment of essential hypertension ray w.
Thiazide and thiazidelike diuretics remain a mainstay of hypertension management. They are recommended among the firstline agents for the management of hypertension and perform very well when added on to other antihypertensives, namely ace. Risks were increased among users of diuretics and other anti. A study in the journal of the american geriatrics society found that about 49% of men ages 40 to 79 with high blood pressure had erectile. Generic name furosemide trade name lasix indication edema, hypertension action prevents reabsorption of sodium and chloride in the kidneys, increase excretion of water, sodium, chloride, magnesium, potassium therapeutic class diuretics pharmacologic class loop diuretics nursing considerations use caution with liver. Diuretics, sometimes called water pills, help rid your body of salt sodium and water. The place of diuretics in the treatment of hypertension ht no longer requires to be proved, but their mode of action remains uncertain. Diuretics for hypertension the structure of hctz and its site of action differ from thiazidelike diuretics figure 2. Role of diuretics in high blood pressure high blood. Diuretic treatment of hypertension ehud grossman, md 1 paolo verdecchia, md, facc, faha, fesc 2 ari shamiss, md 1 fabio angeli, md 3 gianpaolo reboldi, md, phd, msc 4 a lthough thiazide and thiazidelike diuretics are indispensable drugs in the treatment of hypertension, their. Fifty years of thiazide diuretic therapy for hypertension. They help your kidneys take salt and water out of your body.
The mechanisms of action of antihypertensive drugs. Diuretics, thiazidethiazide diuretics are used as monotherapy, or they can be administered adjunctively with other antihypertensive agents. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Use of diuretics in patients with hypertension nejm. Diuretics in hypertension postgraduate medical journal. Diuretics, also called water pills, are a common treatment for high blood pressure. Hctz has a less than 24hour duration of action and is less potent than indapamide indap, chlorthalidone ctdn, angiotensinconvert. Dec 19, 2010 salt homeostasis can also be affected pharmacologically by diuretic drugs that target mechanisms within the distal kidney nephron to cause salt wasting. Loop diuretics were selected as the primary outcome because they are more likely than other diuretics to be used to treat edema and are not generally recommended for management of hypertension, unlike thiazide or thiazidelike diuretics. Which medications in the drug class diuretics, thiazide.
Diuretics are used to treat high blood pressure, edema excess fluid in the tissues, heart failure, liver cirrhosis, hypertension, water poisoning, and certain kidney diseases. The efficacy and safety of diuretics in treating hypertension. Hypertension is resistant to pharmacologic therapy in 5% to 10% of patients. The different classes of diuretics are characterized, along with their mode of action.
Read on to know how natural diuretic foods are more beneficial for controlling high blood pressure levels. Although the pathophysiology of female sexual dysfunction is more complex than the male one, antihypertensive drugs seem to contribute to female sexual dysfunction. Review of the role of spironolactone in the therapy of. Thiazide diuretics are medications that help remove extra fluid volume from the blood through increased urination. Antihypertensive therapy with diuretics is particularly effective when coupled with reduced dietary sodium intake. Thiazide diuretics in hypertension european society of. Salt homeostasis can also be affected pharmacologically by diuretic drugs that target mechanisms within the distal kidney nephron to cause salt wasting. The site of action for thiazides is the nacl cotransporter in the distal convoluted tubule of the nephron, which is responsible for around 5% of total sodium reabsorption. Always ask yourself these 5 questions when you see a drug name to help you understand how the drug works, your role as a nurse, and what information will be asked on an exam about the drug. Role of macula densa in diureticsinduced renin release. Pdf on may 1, 2011, ehud grossman and others published diuretic.
Diuretics thiazide diuretics loop diuretics potassiumsparing diuretics. Hypertension, dietary salt intake, and the role of the. Evaluation of a common prescribing cascade of calcium channel. High blood pressure and erectile dysfunction webmd. However, of late, mainly because of the increased incidence of new onset diabetes mellitus and availability of better drugs with lower side effect profile, diuretics are slowly losing ground. They are often used to treat hypertension, or high blood pressure. Clicking on the drug class will link you to the page describing the pharmacology of that drug class. Pdf diuretics were always the first line drugs in hypertension. Loop diuretics are less effective than thiazidetype drugs in reducing bp in the nonedematous patient as has been shown in a recent cochrane.
Diuretic therapy for hypertension originated in 1937 with the discovery that sulfon amides caused acidemia and mild diuresis by inhibiting. After adjustment for hypertension, risk for diuretics was reduced to unity, except among long. Thiazides and thiazidelike diuretics have remained a cornerstone in the management of hypertension for more than half a century since their introduction in 1958. Thiazide diuretics reduce blood pressure when administered as monotherapy. The importance of diuretic selection when managing. The role of diuretics in female sexual dysfunction remains largely unclarified. Sexual dysfunction is more prevalent in female than in male hypertensive patients. Diuretic treatment of hypertension diabetes care american. Htn has several subclassifications including, htn stage i, htn stage ii, and isolated systolic htn. View the article pdf and any associated supplements and figures for a period of 48 hours.
The role of these drugs in the treatment of primary hypertension is discussed elsewhere. Clinical pharmacology of antihypertensive therapy for the. Diuretics, also known as water pills, belong to a class of medications that remove excess salt and water from the body. Thiazide diuretics reduce blood pressure when administered as. There are also questions regarding which diuretics to chose. Role of diuretics in high blood pressure role of diuretics in high blood pressure, diuretics may be used to treat a number of heartrelated conditions, including high blood pressure, heart failure, kidney and liver problems, and glaucoma. Most of them help your kidneys release more sodium into your urine. The european society of cardiologyeuropean society of hypertension escesh guidelines recommend that thiazide diuretics should be considered as suitable as. Although thiazide and thiazidelike diuretics are indispensable drugs in the treatment of hypertension, their role as firstline or even secondline drugs is a provoking debate. Renin release in intact hydropenic rats was not altered by diuretic therapy, but furosemide increased plasma renin activity in hydropenic as well as in. Diuretic dosing and adverse effects are discussed separately. Setaro, marvin moser, in comprehensive hypertension, 2007. Review of the role of spironolactone in the therapy of children. There are several general measures and pharmacological agents that are known to treat hypertension adequately.
The combined use of thiazidelike diuretics with aldosterone antagonists may be worthwhile. High blood pressure is a major cause of erection problems. Evidence based management of hypertension is known to improve both the short term and the long term outcomes in patients with this condition. Diuretics for hypertension often come with side effects. Role of diuretics in treatment of essential hypertension. Which medications in the drug class diuretics, thiazide are. Diuretics were always the first line drugs in hypertension. Pharmacology and clinical use of diuretics katie herndon, pharm. Diuretics are primarily used to treat hypertension and edematous states resulting from a variety of causes, for example, congestive heart failure, nephritic syndrome, and chronic liver disease thiazide, loop and potassiumsparing diuretics jackson 1996. Now that you know the purpose of water pills and how they work, it is easy to understand why natural diuretics should be used to control high blood pressure. Though hydrochlorothiazide is the commonly used drug, data. Several recent guidelines underscore the importance of treating patients with a history of stroke or transient ischemic attack with a diuretic and. Thus, diuretics should remain the leading agents in the management of hypertension. Combined with thiazidetype diuretics, potassiumsparing agents decrease ventricular ectopy and.
The antihypertensive and lipidlowering treatment to prevent heart attack trial allhat stipulated assessment of the relative effect of chlorthalidone, lisinopril, and amlodipine in preventing hf. An account is given of the adverse effects of diuretics and how they come about. Evaluation of a common prescribing cascade of calcium. The direct action of the diuretics on reninproducing cells was examined in isolated glomeruli. Role of natural herbs in the treatment of hypertension. Role of diuretics in the prevention of heart failure. However, the diuretics are also used to reduce intraocular pressure osmotics, carbonic. However, of late, mainly because of the increased incidence of new onset. Diuretics have many of the attributes of the ideal stepone drug. The current study tested whether addition of spironolactone to the treatment of patients with refractory hypertension would lead to adequate blood pressure bp control. Treatment of hypertension that uses a diureticbased strategy has been effective in preventing stroke and cardiac disease in the earliest randomized clinical trials in the 1960s, with a consistently successful track record extending to contemporary trials, as emphasized in allhat. Indeed, essential hypertension appears to be a multifactorial disorder. Boston university school of medicine, boston, mass. A systolic or the diastolic bp measurement higher than the accepted normal values for the age of the individual is classified as prehtn or htn.
Potassiumsparing diuretics are used as a more effective alternative to potassium supplements for prevention of hypokalaemia induced by thiazide diuretics. The role of diuretics in the treatment of hypertension. These drugs are very effective in the elderly and very elderly patients. Hypertension is a major cause of heart failure hf and is antecedent in 91% of cases. Role of diuretics in high blood pressure, diuretics may be used to treat a number of heartrelated conditions, including high blood pressure, heart failure, kidney and liver problems, and glaucoma. Consecutive female hypertensive patients between 30 and 70 years of age attending our hypertension outpatient clinic who initiated diuretic therapy participated in the study. Ckd is common and frequently complicated with hypertension both predialysis and in eskd. The ability to induce negative fluid balance has made diuretics useful in the treatment of a variety of conditions, particularly edematous states and hypertension. The role of diuretics in the treatment of heart failure. As a major modifiable risk factor for cardiovascular disease in this highrisk population, treatment of hypertension in ckd is important. High blood pressure can be a contributing factor in the development of various forms of heart disease. Numerous large randomized clinical trials have demonstrated the value of these agents in reducing morbidity and mortality in the hypertensive patient. In the setting of low renin hypertension, diuretics elevate renin in a dosedependent manner and, therefore, would be expected to enhance the efficacy of angiotensinconverting enzyme inhibitors and aldosterone receptor blockers. Oct 19, 2019 diuretics, also called water pills, are a common treatment for high blood pressure.
Article in french olmer m, ducros j, grandvuillemin m, salvadori jm. Thiazide diuretics inhibit reabsorption of sodium and. Dont forget to take the thiazide diuretics quiz after. Most patients with hypertension, of which 9095% have hypertension of unknown origin primary or essential hypertension, are effectively treated with diuretics. Thus, reduction of extracellular k levels need not significantly influence intracellular k.
We will focus on the three diuretic classes used to treat hypertension. Those who can excrete excess salt at normal levels of blood pressure are called salt resistant. Thiazides improve cardiovascular outcomes, including stroke, heart failure, coronary events, and death 36,37. If the symptoms of high blood pressure are not very severe, then the condition can be managed with the help of proper diet and use of natural diuretics. Monotherapy with a diuretic adequately controls hypertension in many patients with mild hypertension diastolic blood pressure between 90 and 104 mm hg. The mechanisms of action of antihypertensive drugs diseases.
Gifford jr md oral diuretics have traditionally been firstline step 1 agents for initiating antihypertensive therapy in the steppedcare approach to management. As chronic kidney disease transitions from stage 3 to 5, particularly with extracellular fluid volume expansion, loop diuretic therapy becomes the preferred diuretic therapy for management of hypertension. Urine output in such patients can be reduced with a low sodium diet, nsaids and thiazide diuretics. Find out how they work and when you might need them. The difference may be due to an inherited defect in the kidney to excrete salt. The pharmacologic treatment of systemic hypertension. Traditionally, nephrologists have focused on a defect in the saltexcreting capacity of the kidney as pivotal to edema formation in heart failure. The latest hypertension guidelines have underscored the importance of diuretics for all patients, but. Hypertension is a common condition associated with increased mortality and multiple morbidities. Diuretics, in particular thiazide compounds, were the earliest forms of practical and welltolerated antihypertensive drugs introduced in the modern therapeutic era.
In any event, salt sensitive hypertension is effectively controlled with the administration of diuretics. In total, 218 female hypertensive patients participated in the study. Although thiazide and thiazidelike diuretics are indispensable drugs in the treatment of hypertension, their role as firstline or even secondline drugs. Thiazide diuretics appear to exert their effect by a combination effects, one of which is by producing a mild hypovolemia, which causes an increase in proximal sodium and water reabsorption, and decreased water delivery to the adhsensitive sites. Diuretics, often called water pills, are usually the first type of high blood pressure medicine your doctor will try. An oral diuretic has been the most popular stepone drug for the treatment of hypertension in the united states for more than 15 years.
The new england journal of medicine n engl j med 361. The current treatment of essential hypertension is based on the following concepts. What are the side effects of diuretics water pills for. Diuretics which lead to frequent urination are used to treat high blood pressure. Hypertension is more prevalent in adults, however, in recent years, hypertension and its sequelae are being seen with increasing frequency in children. The extracellular fluid and plasma volumes are reduced and, as a result, right heart filling pressure, cardiac output, and blood pressure if abnormally. Use of thiazide diuretics in patients with primary essential. This chapter tries to find out the current role of diuretics in hypertension. 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 costeffectiveness profile. The mechanism of the antihypertensive effect of chlorothiazide does not differ trom that of such potent salt. Unlimited viewing of the articlechapter pdf and any associated supplements and figures.
461 645 254 1275 897 986 984 350 903 593 940 125 1252 673 1376 1217 319 1309 607 1191 520 720 154 1133 938 1139 353 540 1115 780 982 22 1321 1409 1214 905 1092