Diuretics hypertension

When adrninistered long-term for the treatment of hypertension, diuretics fulfill the goals of preventing cardiovascular disease and increasing longevity. However, diuretic therapy may produce both side and toxic effects that are significant in certain patient subgroups, eg, diabetics and cardiac patients. 

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... 

In situations of known renin-angiotensin-aldosterone involvement, such as in hypertension secondary to renal disease (i.e., renovascular hypertension), diuretics probably should not be used because they further elevate plasma renin. 

A standard treatment for hypertension, diuretics flush excess water and sodium from the body. They also lower blood pressure by reducing the total volume of... 

The thiazide diuretics are primarily used for most patients with mild or moderate hypertension. Used alone they can lower blood pressure by 10-15 mmHg. In more severe hypertension diuretics are used in combination with other agents. Adverse effects include hypokalemia (lowered serum potassium), impotence, impaired glucose tolerance, hyperlipidemia, and hyperuricemia (elevated uric acid in the blood). 

The drugs of first choice in antihypertensive therapy are those that have been unambiguously shown in clinical studies to reduce mortality of hypertension—diuretics, ACE inhibitors and AT, antagonist, p-blockers, and calcium antagonists. 

In the treatment of hypertension, diuretics are commonly used in combination with other classes of drugs, usually -blockers (see P-adrenoceptor antagonists). 

That have comparable effects, especially if combination products (e.g. anti-hypertensive-diuretic combinations). 

AGE inhibitors such as captopril may facilitate the differential diagnosis of renovascular hypertension diuretics such as fiirosemide (Lasix) cause rapid washout of the radiotracer or demonstrate urinary tract obstruction (Kletter 1988). 

Note A component of Normatensyl. therap cat Anti hypertensive diuretic. 

Diuretic drugs (thiazide and loop diuretics) are administered orally to help control blood pressure in the treatment of hypertension. Diuretics often are the first drugs used to treat hypertension, and they also may be added to other drug therapies used to control blood pressure with beneficial effects. 

Calcium channel blockers normalize the blood pressure in about 80% of hypertensive patients older than 60 years of age, 50% of those between 40 and 60 years of age, and only 20% of patients under 40 years of age. Thus calcium channel blockers are best for patients who are elderly and have low PRA and mosdy ineffective in patients who have high PRA. This responsiveness profile is very similar to that of the diuretics. 

Calcium channel blockers cause more pronounced lowering of blood pressure in hypertensive patients than in normotensive individuals. Generally, all calcium channel blockers cause an immediate increase in PRA during acute treatment in patients having hypertension but PRA is normalized during chronic treatment despite the sustained decrease in blood pressure. These agents also do not generally produce sodium and water retention, unlike the conventional vasodilators. This is because they produce diuretic effects by direct actions on the kidney. 

Diuretics are needed to return to normal the expanded extracellular volume that other antihypertensive agents produce, such as fluid retention and blood volume expansion, via compensatory mechanisms of the body. The loss of efficacy of antihypertensive agents can be restored if a diuretic is used concomitandy. In the treatment of hypertension, high ceiling or loop diuretics, such as furosemide, ethacrynic acid, and bumetanide, are no more efficacious than the thiazide-type of diuretics. In fact, these agents cause more side effects, such as dehydration, metaboHc alkalosis, etc, and therefore, should not be used except in situations where rapid elimination of duid volume is cleady indicated. 

Methyldopa is effective in mild, moderate, and severe hypertension but a thiazide-type diuretic is needed to overcome the fluid retaining side effect. Methyldopa has been shown to prevent and induce regression of ventricular hypertrophy in hypertensive patients. The principal side effects are sedation, drowsiness, nasal congestion, fluid retention, and in rare occasions, hemolytic anemia. 

Hypokalemia. Hypokalemia associated with thia2ide diuretic therapy has been knpHcated in the increased incidence of cardiac arrhythmias and sudden death (82). Several large clinical trials have been conducted in which the effects of antihypertensive dmg therapy on the incidence of cardiovascular complications were studied. The antihypertensive regimen included diuretic therapy as the first dmg in a stepped care (SC) approach to lowering the blood pressure of hypertensive patients. 

Diuretics are one of the dmg categories most frequendy prescribed. The principal uses of diuretics are for the treatment of hypertension, congestive heart failure, and mobilization of edema fluid in renal failure, fiver cirrhosis, and ascites. Other applications include the treatment of glaucoma and hypercalcemia, as well as the alkafinization of urine to prevent cystine and uric acid kidney stones. 

The sales of oral diuretics are declining, and are forecast to continue their decline in constant dollars during the 1990s (119,120). Several possible explanations can be offered for these trends. The patents of market leaders are expiring, lea ding to the introduction of generic brands at ca 40% below the cost of the branded market leaders physicians are switching to newer treatments for hypertension, eg, calcium channel blockers and... 

The efficacy of these diuretics led to their extensive use in the clinic, particularly in treatment of hypertension. In theory at least, reduction of the blood volume by diuresis should lead to a lowering of pressure (PV=RT). This expectation was in fact met in actual practice. Recent research does, however, seem to indicate that the thiazides have an antihypertensive effect beyond that explainable by a simple lowering of blood volume. 

Thiazide diuretics have a venerable history as antihypertensive agents until the advent of the angiotensin-converting enzyme (ACE) inhibitors this class of drugs completely dominated first line therapy for hypertension. The size of thi.s market led until surprisingly recently to the syntheses of new sulfonamides related to the thiazides. Preparation of one of the last of these compounds starts by exhaustive reduction of the Diels-Alder adduct from cyclopentadiene and malei-mide (207). Nitrosation of the product (208), followed by reduction of the nitroso group of 209,... 

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