Hydrochlorothiazide hypertension

Amiloride (Midamor) is used in the treatment of CHF and hypertension and is often used with a thiazide diuretic. Spironolactone and triamterene are also used in tiie treatment of hypertension and edema caused by CHF, cirrhosis, and the nephrotic syndrome Amiloride, spironolactone, and triamterene are also available with hydrochlorothiazide, a thiazide diuretic that enhances tiie antihypertensive and diuretic effects of the drug combination while still conserving potassium. 

The testing of impnrities in active pharmacentical ingredients has become an important initiative on the part of both federal and private organizations. Franolic and coworkers [113] describe the utilization of PLC (stationary phase — silica gel and mobile phase — dichloromethane-acetonitrile-acetone (4 1 1, v/v)) for the isolation and characterization of impurities in hydrochlorothiazide (diuretic drug). This drug is utilized individually or in combination with other dmgs for the treatment of hypertension. The unknown impurity band was scraped off the plate and extracted in acetonitrile. The solution was filtered and used for LC/MS and NMR analysis. The proposed procedure enabled the identification of a new, previonsly nnknown impurity. It was characterized as a 2 1 hydrochlorothiazide-formaldehyde adduct of the parent drug substance. 

Two types of diuretics are used for volume management in HF thiazides and loop diuretics. Thiazide diuretics such as hydrochlorothiazide, chlorthalidone, and metolazone block sodium and chloride reabsorption in the distal convoluted tubule. Thiazides are weaker than loop diuretics in terms of effecting an increase in urine output and therefore are not utilized frequently as monotherapy in HF. They are optimally suited for patients with hypertension who have mild congestion. Additionally, the action of thiazides is limited in patients with renal insufficiency (creatinine clearance less than 30 mL/minute) due to reduced secretion into their site of action. An exception is metolazone, which retains its potent action in patients with renal dysfunction. Metolazone is often used in combination with loop diuretics when patients exhibit diuretic resistance, defined as edema unresponsive to loop diuretics alone. 

CH, a 42-year-old man, comes into the emergency department after his sister discovered him seizing at home. He has a history of hypertension, diabetes, epilepsy, and rheumatoid arthritis. His medications include hydrochlorothiazide, gly-buride, phenytoin, and aspirin. He smokes one pack per day, drinks heavily on the weekends, and has a history of cocaine use. Upon further discussion with his sister, you discover that he stopped taking his phenytoin 4 days ago due to failure to obtain a refill from his doctor. He is currently unarousable since his last seizure 10 minutes ago. 

LP is a 58-year-old man with newly diagnosed stage IIIA non-small cell lung cancer who presents to the clinic complaining of loss of appetite, excess thirst, nausea and vomiting, and confusion x 2 days. The medication history lists NKDA, hydrochlorothiazide 50 mg by mouth daily for hypertension, and naproxen 500 mg by mouth twice daily for arthritis. 

A 50-yea.r-old male with a two-year history of essential hypertension well controlled on hydrochlorothiazide is found on a recent physical examination to have a blood pressure of 160/105 mmHg. The hydrochlorothiazide is substituted with another agent. Two weeks later, he returns for follow-up complaining of a loss of taste. 

Maxzide Maxzide-25 Anti hypertensive Diuretic Tab Triamterene 75 mg. hydrochlorothiazide 50 mg Tab Triamterene 37.5 mg. hydrochbrothiazide 25 mg 1 tab qd jaundice, pancreatitis, interstitial nephritis, renal stones. 1-2 tab qd... 

Thiazide diuretics (benzothiadia-zines) include hydrochlorothiazide, benzthiazide, trichlormethiazide, and cyclothiazide. A long-acting analogue is chlorthalidone. These drugs affect the intermediate segment of the distal tubules, where they inhibit a Na+/Ch cotransport, Thus, reabsorption of NaQ and water is inhibited. Renal excretion of Ca decreases, that of Mg + increases. Indications are hypertension, cardiac failure, and mobilization of edema. 

In addition to the thiazide diuretics like hydrochlorothiazide (19) and chlorthalidone used in the treatment of hypertension for a long time, a few newer diuretics such as azosemide and torasemid (188) have been introduced for... 

Carter BL, Ernst ME, Cohen JD. Hydrochlorothiazide versus chlorthahdone evidence supporting their interchangeabtiity. Hypertension 2004 43 4-9. 

Diuretics - Generally initiate therapy with a thiazide or other oral diuretic. Thiazide-type diuretics are drugs of choice hydrochlorothiazide or chlorthalidone are generally preferred. Reserve loop diuretics for selected patients. This therapy alone may control many cases of mild hypertension. Consider treating diuretic-induced hypokalemia (less than 3.5 mEq/L) with potassium supplementation or by adding a potassium-sparing diuretic to therapy. 

Hypertensive patients with ieft ventricuiar hypertrophy - The usual starting dose is 50 mg of losartan once daily. Add hydrochlorothiazide 12.5 mg/day and/or increase the dose of losartan to 100 mg once daily followed by an increase in hydrochlorothiazide to 25 mg once daily based on blood pressure response. 

These agents inhibit sodium reabsorption at the level of the distal tubulus (Fig. 7). They are rather mild and slow-acting diuretics, mainly used in the longterm treatment of essential hypertension. The various compounds available all act via the same principle. There exist differences in the onset and duration of action. In practice very few drugs are sufficient, such as hydrochlorothiazide, a well-known example. Other thiazides are chlorthiazide, chlortalidon and indapamide. 

When diuretic therapy is indicated for the treatment of primary hypertension, the thiazide-type compounds (e.g., chlorothiazide, hydrochlorothiazide) are generally the drugs of choice. They can be used alone or in combination with other antihypertensive agents Approximately 30% of patients with mild hypertension may be treated effectively with thiazide therapy alone. 

L A man aged 74 has moderate hypertension controlled with hydrochlorothiazide 12.5 mg once daily and losartan 50 mg once daily. He is prescribed ro-fecoxib 50 mg once daily to control osteoarthritis pain. After 3 months of this therapy, his blood pressure begins to rise. This increase in blood pressure is most likely due to... 

Thiazides Hydrochlorothiazide Block Na/CI transporter in renal distal convoluted tubule Reduce blood volume plus poorly understood vascular effects Hypertension, mild heart failure ... 

Jamerson et al Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl 3 Med 2008 359 2417. [PMID 19052124]... 

Hydrochlorothiazide Decreases NaCI reabsorption in the distal convoluted tubule Same as furosemide, but less efficacious Mild chronic failure mild-moderate hypertension hypercalciuria Oral only duration 10-12 h Toxicity Hyponatremia, hypokalemia, hyperglycemia, hyperuricemia, hyperlipidemia, sulfonamide allergy... 

Hydrochlorothiazide Inhibition of the Na/CI transporter in the distal convoluted tubule Modest increase in NaCI excretion some wasting hypokalemic metabolic alkalosis t decreased urine Ca Hypertension, mild heart failure, nephrolithiasis, nephrogenic diabetes insipidus Oral duration 8-12 h Toxicity Hypokalemic metabolic alkalosis, hyperuricemia, hyperglycemia, hyponatremia... 

Inhibition of the renin-angiotensin system with ACE inhibitors or ARBs may be incomplete because the drugs disrupt the negative feedback action of Ang II on renin secretion and thereby increase plasma renin activity. Other antihypertensive drugs, notably hydrochlorothiazide and other diuretics, also increase plasma renin activity. Aliskiren not only decreases baseline plasma renin activity in hypertensive subjects but also eliminates the rise produced by ACE inhibitors, ARBs, and diuretics and thereby results in a greater antihypertensive effect (Figure... 

The metabolic effects of indapamide appear to be as common as those of thiazides (SEDA-14, 185 SEDA-15, 216). The metabolic effects of hydrochlorothiazide 25 mg/day and indapamide 2.5 mg/day for 6 months have been compared in a randomized, double-blind study in 44 patients with mild to moderate hypertension (485). There was little difference between the effects of the drugs on a wide range of lipid parameters, glucose, and potassium. The purported metabolic differences with indapamide are unlikely to be of sufficient magnitude to warrant its preferential use in hyperlipidemia. 

Spence JD, Huff M, Barnett PA. Effects of indapamide versus hydrochlorothiazide on plasma lipids and lipoproteins in hypertensive patients a direct comparison. Can J Clin Pharmacol 2000 7(l) 32-7. 

Boyden TW, Nugent CA, Ogihara T, Maeda T. Reserpine, hydrochlorothiazide and pituitary-gonadal hormones in hypertensive patients. Eur J Clin Pharmacol 1980 17(5) 329-32. 

Demographic, environmental, and genetic predictors of metabolic side effects of hydrochlorothiazide treatment in hypertensive subjects. Am J Hypertens 2005 18 1077-83. 

Often, diuretics are used in combination with other drugs to relieve hypertension. Types of diuretics used to treat hypertension include thiazides, such as chlorothiazide (Diuril) and hydrochlorothiazide (Esidrex) potassium-sparing diuretics, such as spironolactone (Aldac-tone) and loop diuretics, such as furosemide (Lasix). 

FIGURE 10.15 Early treatments for hypertension propranolol and hydrochlorothiazide... 

The randomized controlled clinical trials performed by Freis and his colleagues at the Veterans Administration Hospitals have provided some of the first solid evidence that moderate permanent hypertension has an improved prognosis when actively treated by sodium depletion (hydrochlorothiazide), by interruption of the sympathetic nervous system (reserpine) and with a vasodilator (hydralazine) (262). In parallel, the beneficial effects of this triple therapy were demonstrated in spontaneously hypertensive rats by the spectacular prevention and cure of their cardiac, vascular, and renal lesions (263). 

Valsartan (22) is an orally active, angiotensin II antagonist that is marketed under the name Diovan by Novartis for hypertension. Novartis has also developed a combination therapy, valsartan plus hydrochlorothiazide, for the second-line therapy of hypertension. The synthesis is straightforward from a stereochemical viewpoint because a chiral pool synthesis is used. The stereogenic center is derived from L-valine (Scheme 31.17).220 223... 

One of the earliest strategies for the management of hypertension was to alter sodium balance by restriction of salt in the diet. Pharmacological alteration of salt balance became practical in the 1950s with the development of the orally active thiazide diuretics. Hydrochlorothiazide is a prototypic drug. Thiazides and related diuretics make up the most frequently used class of antihypertensive agents in the United States. 

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