Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “DIURETICS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 487 records · Page 27Linked to original sources
PubMed1991

Diuretic drug use and the risk for hip fracture.

OBJECTIVE: To test the hypothesis that use of thiazide diuretics prevents hip fracture and to study the risk for hip fracture associated with furosemide use. DESIGN: A case-control study. SETTING: Hospitals owned by a health maintenance organization in Washington. PATIENTS: Elderly patients (n = 462) hospitalized because of a hip fracture between 1977 and 1983 and an equal number of age- and sex-matched population-based control patients. MEASUREMENTS: Use of thiazide diuretics and furosemide was ascertained from medical records and computerized pharmacy records. The relative risk for hip fracture associated with diuretic use was calculated and adjusted for the potentially confounding effects of nursing home residence; previous hospitalizations; a history of stroke, alcoholism, or the organic brain syndrome; body weight; leg paralysis; and use of phenobarbital, corticosteroids, or other diuretics. Current and former users of diuretics were analyzed separately. MAIN RESULTS: The adjusted risk for hip fracture was 1.6 (95% CI, 1.0 to 2.5) for current thiazide users. The adjusted risk for hip fracture for current furosemide use was 3.9 (CI, 1.5 to 10.4). CONCLUSIONS: According to this study, use of thiazide diuretics did not protect against hip fracture and cannot be recommended for fracture prevention. Current furosemide use was also associated with hip fracture.

Aged↗
PubMed1995

The efficacy and safety of diuretics in treating hypertension.

The efficacy of thiazides and related diuretics in preventing most of the complications of hypertension has been conclusively documented in long-term controlled trials. Among their adverse effects, thiazides may induce a short-term increase in serum cholesterol levels. However, the elevation returns to pretreatment levels during long-term therapy. In addition, long-term treatment with thiazides is not associated with an elevation of blood glucose levels or an increased incidence of diabetes. Because the long-term controlled trials have shown that thiazides provide more protection against stroke than against coronary heart disease events, it is possible that the difference may be caused by adverse effects of the diuretics. In three of four recent trials that used low doses of thiazides plus potassium-sparing diuretics, the number of sudden deaths was reduced more than in other trials that used high doses of diuretics alone. A recent case-control study also found that small doses of diuretics combined with potassium-sparing drugs were associated with a reduced number of sudden deaths compared with high doses used alone. Although these results suggest that small doses reduce the risk for sudden death more than do large doses, they cannot be regarded as conclusive. A randomized double-blind trial comparing low and high doses of thiazide diuretics and potassium-sparing drugs must be done. For now, however, small doses seem prudent for treating hypertension.

Arrhythmias, Cardiac↗
PubMed1977

Diuretic therapy and response of essential hypertension to saralasin.

Thirty-four patients, most with a low-renin "essential" hypertension, and seven normal subjects were placed on diuretic therapy for 4 to 5 weeks. In the normal subjects, infusion of a highly specific, competitive angiotensin II analogue (1-sar-8-ala-angiotensin II, saralasin) did not significantly change recumbent blood pressure either before or after diuretic administration. In contrast, the hypertensive patients as a group had a low stimulated plasma renin activity before diuretic therapy and a rise in blood pressure during saralasin infusion. After therapy, the stimulated plasma renin activity was higher and saralasin produced a fall in blood pressure in some patients who were still hypertensive. The results suggest that short-term diuretic therapy, which is thought to act through its natriuretic effects, can convert some patients with essential hypertension, many with a low or a low-normal stimulated plasma renin activity, to individuals whose hypertension is supported by angiotensin II. The fall in blood pressure to saralsin infusion after diuretic therapy was directly proportional to the height to which diuretics elevated the stimulated plasma renin activity.

Adult↗
PubMed1975

The effect of diuretic treatment on red cell and plasma sodium concentration in patients with hepatic cirrhosis and ascites.

The sodium content of red cells and plasma in some cirrhotic patients with ascites has been measured, before, during and after diuretic treatment. The results were compared with those found in 37 normal subjects and 42 untreated cirrhotic patients with ascites. In the 10 cirrhotic patients with ascites studied, the mean sodium content in erythrocytes before diuretic treatment was 9.95 (+1- SD 3.27) mEQ/kg, 27.15 (+/- SD 5.60) mEq/kg of dry weight and 15.02 (+/- SD 2.70) mEq/kg of red cell water. During diuretic treatment, the mean sodium content in red cells was significantly decreased to 6.27 (+/- SD 1.46) mEq/kg; 18.85 (+/- SD 4.36) mEq/kg of dry weight and 10.15 (+/- SD 2.41) mEq/kg of red blood cell water (P less than 0.01, P less than 0.01, and P less than 0.02 respectively). The mean plasma sodium concentration which was 135.95 (+/- SD 4.14) mEq/kg before diuretic treatment was significantly decreased during treatment to 129.19 (+/- SD 2.77) mEq/kg, P less than 0.001. Once the ascites had disappeared and the diuretic treatment had been discontinued the sodium concentration in both plasma and red cells became normal. The radioactive 22Na exchange "in vitro" between plasma and red cells of cirrhotic patients with ascites remained unmodified during diuretic treatment.

Ascites↗
PubMed2001

Influence of the angiotensin II receptor antagonist losartan on diuretic-induced metabolic effects in elderly hypertensive patients: comparison with a calcium channel blocker.

OBJECTIVE: Diuretic therapy frequently induces undesirable biochemical changes and side effects. We compared metabolic effects of a low-dose diuretic (D) given in combination with an angiotensin II receptor antagonist, losartan (L), with those resulting from a diuretic given in combination with a calcium channel blocker, slow-release nifedipine (N). MATERIAL AND METHODS: Thirty-seven elderly patients with mild to moderate hypertension (mean age: 71 +/- 3 years) were treated with either L+D (n = 18) or N+D (n = 19) for 1 year. Diuretic therapy included low-dose trichlormethiazide or low-dose furosemide in numbers of patients that were similar between L+D and N+D groups. Blood pressure, serum electrolytes, uric acid, blood glucose, renal function and lipid parameters were measured at baseline, 6 months and 1 year. RESULTS: Effective blood pressure control was observed in both groups at 6 months, and with further improvement at 1 year. Serum potassium was significantly decreased from baseline at 6 months (p < 0.01) and 1 year (p < 0.01) in the N+D group, but not in the L+D group. Serum uric acid was significantly increased from baseline at 6 months (p < 0.01) and 1 year (p < 0.01) in the N+D group, but had minimally decreased at 1 year in the L+D group (p < 0.1). Blood glucose, renal function and lipid parameters did not change in either group. CONCLUSION: The combination of losartan and low-dose diuretics effectively treated hypertension in elderly patients while minimizing the metabolic consequences of diuretic therapy. Larger trials will be necessary to confirm this finding.

Aged↗
PubMed2002

Severe electrolyte disturbances and renal failure in elderly patients with combined diuretic therapy including xipamid.

UNLABELLED: Diuretics are among the most frequently prescribed substances in elderly patients, but they are also associated with the highest incidence of adverse effects in this group of patients. Xipamide is a sulfonamide-like diuretic whose action does not depend on transtubular secretion. This characteristic makes it suitable for situations in which the kidney is highly sodium avid. Because of the potency of this substance the risk of adverse reactions like electrolyte disorders or hypovolemia is increased as well. We report seven patients (age 65-85) admitted to the emergency room of the University Hospital of Innsbruck between 1998 and 2002 who had developed serious adverse reactions upon initiation of treatment with xipamide as an additional diuretic. Six of these patients had received combinations with loop diuretics. The disturbances observed were hyponatremia (lowest value 108 mmol/l), hypokalemia (lowest value 1.5 mmol/l) and prerenal azotemia (highest serum urea 269 mg/dl, highest serum creatinine 5.13). CONCLUSION: With the exception of diuretic resistance in severe heart failure or renal insufficiency a combination therapy of xipamide with a second diuretic appears to be associated with an unnecessarily high risk of serious adverse reactions and thus should be avoided. This is especially true for elderly patients.

Age Factors↗
PubMed1992

The place of loop diuretics in the treatment of acute and chronic renal failure.

Loop diuretics (furosemide, bumetanide, muzolimine, piretamide, torasemide) are powerful drugs capable of increasing sodium excretion and urine output even when renal function is markedly impaired. In patients with chronic renal failure (CRF), loop diuretics may be given to control extracellular volume (ECV) expansion responsible for hypertension. But the use of loop diuretics in chronic uremia is mostly helpful when impaired renal function co-exists with nephrotic syndrome or chronic heart failure. Due to their powerful natriuretic activity, loop diuretics have been administered also to patients on maintenance dialysis to reduce the frequency of and/or to curtail dialysis time. In this condition, however, the increase of sodium and water excretion is very limited; whereas the use of diuretics in high dosage is not devoid of risky side effects such as neurologic lesions, cramps, deafness, weakness, muscle pain. In some patients with oliguric form of acute renal failure (ARF), loop diuretics increase sodium excretion and urine output. They do not affect the mortality rate for ARF but may facilitate the treatment of patients by reverting an oliguric form to a non-oliguric form of ARF.

Acute Kidney Injury↗
PubMed2005

The F + 0 protocol for diuretic renography results in fewer interrupted studies due to voiding than the F - 15 protocol.

UNLABELLED: Timing of diuretic administration is not universally standardized in renography. Over the past year, our practice has changed from F-15 administration of furosemide to an F + 0 protocol. Therefore, we have retrospectively compared these 2 cohorts to assess if the shorter interval between diuretic administration and study completion in the F + 0 study results in a greater frequency of patients able to complete the subsequent 30-min dynamic acquisition without disruption due to voiding. METHODS: We identified 108 diuretic (99m)Tc-mercaptoacetyltriglycine renograms performed in the previous 18-mo period. Three patients were given furosemide at 30 min after the radiopharmaceutical and were excluded. Twenty studies in children under 3 y of age were excluded from consideration because voiding is neither restricted in this age group nor does voiding into a diaper cause disruption. Forty milligrams of furosemide were administered to adults, whereas 0.5 mg/kg was given to children. In the first cohort of 56 studies, radiopharmaceutical was administered 15 min after furosemide (F-15), whereas, in the second cohort of 29 patients, it was administered immediately thereafter (F + 0). In all cases, patients were asked to void proximal to radiopharmaceutical injection. Dynamic images and renogram curves were inspected for evidence of interruption or voiding midstudy. Statistical significance was determined by a 1-tailed Fisher exact test for proportions, with P < 0.05. RESULTS: The F-15 and F+0 groups of patients were comparable in terms of age, sex, and diuretic amount. In 17 of the F-15 patients, renography was interrupted because of voiding (30%), whereas this occurred in only 3 of the F + 0 patients (10%). This difference was significant at the P = 0.033 level. The mean time of voiding was 18.3 min (range, 12-25 min) for F-15 patients and 16 min (range, 12-19 min) for the F + 0 group. CONCLUSION: The F + 0 renal diuretic protocol is associated with a significantly lower rate of disruption because of voiding than the F-15 protocol, likely due to the shorter period between diuretic administration and study termination, which results in less bladder distention and discomfort. On the basis of these data, the F + 0 protocol appears to be a more tolerable procedure.

Adolescent↗
PubMed2006

[The diuretic in chronic cardiac failure: a clumsy partner].

Ever since the publication of the large scale clinical trials of morbid-mortality, the recommendations concerning the medical treatment of cardiac failure are clear with respect to ACE inhibitors, betablockers, angiotensin receptor antagonists and aldosrerone antagonists with established target doses. As far as the prescription of diuretics go, drugs which are effective in a condition associated with a poor quality of life, it is important to use the minimal dosage because of their deleterious stimulant effects on the rennin-angiotensin-aldosterone system and their metabolic side effects. A review of the clinical trials shows that almost all patients were prescribed diuretics; in over 80% of cases, the drugs are loop diuretics with a preference for furosemide, with increasing doses during the follow-up, infrequently associated with thiazide diuretics. In the short term, diuretics reduce the circulating volume and the BNP. In the long term, high doses are associated with a poor prognosis. The clinician then has to decide on the basis of few objective criteria, especially for the reduction of dosage, despite the introduction of the BNP whose role as an aid to prescription remains to be defined. In addition to the simple prescription of drugs, a global approach to patient management is necessary in cardiac failure; in this context, concerning salt- water equilibrium and diuretics, therapeutic education may have a solid role to play to provide an acceptable quality of life including the reduction of the number of frequent hospital admissions.

Age Factors↗
PubMedDate not supplied

Comparison of the diuretic effect of furosemide mixed with human albumin or fresh frozen plasma for patients with hypoalbuminemia in the intensive care unit.

BACKGROUND: Diuretics are commonly used in the intensive care unit (ICU) for patients with fluid over-loading. Hypoalbuminemia is a major cause of diuretic resistance. Albumin mixed with furosemide can promote diuresis and sodium excretion in patients with hypoalbuminemia. The purpose of this study is to compare the diuretic effect of furosemide (FU) mixed with human albumin (HA) or fresh frozen plasma (FFP) in ICU patients with hy-poalbuminemia. METHODS: Patients with fluid overloading and hypoalbuminemia who needed diuretic treatment were enrolled and were divided into 2 groups: the first group having clearance of creatinine (CCr) >20 ml/min, and the second group having CCr < or = 20 ml/min. FU (60 mg) mixed with HA (HA group), 60 mg FU mixed with FFP (FFP group) and water (placebo group) were given intravenously to these patients for 60 minutes in random order on the first, third and fifth day. After drug administration, 8-hour urine was collected, and urine amount and urinary sodium excretion were checked. RESULTS: Both the HA group and the FFP group had significantly higher urinary volume and sodium excretion than the placebo group in the patients with CCr >20 ml/min or CCr < or = 20 ml/min (p < 0.01). In the patients with CCr >20 ml/min, there was no difference in the amount of urine excretion and cumulative urinary sodium excretion between the HA group and FFP group. In the patients with CCr < or =ml;20 ml/min, the HA group had a significantly higher urine output and urinary sodium excretion than the FFP group (p < 0.05). CONCLUSIONS: In ICU patients, 60 mg FU mixed with HA or FFP has a similar diuretic effect in patients with CCr >20 ml/min. FFP is an effective alternative choice for improving diuresis for ICU patients with hypoalbuminemia. In patients with CCr < or = 20 ml/min, albumin mixed with 60 mg FU has a superior diuretic effect compared with FFP mixed with FU.

Adult↗
PubMed1992

Renal and antihypertensive effects of a novel eukalemic diuretic, ICI 207,828.

ICI 207,828, an aminomethylphenol pyrazine derivative, produces water diuretic effects with only minimal alterations in kaliuresis in dogs and rats after oral and parenteral administration. In the dog, ICI 207,828 reached maximum activity at a dose of 10 mg/kg, p.o. This was comparable to that of hydrochlorothiazide (HCTZ) at a dose of 5 mg/kg, p.o. or higher. In the rat, a dose of 30 mg/kg, p.o. of ICI 207,828 was comparable to the maximum of water diuretic and saluretic response obtained with HCTZ at a dose of 10 mg/kg, p.o. Based upon studies using in vitro amphibian models of the mammalian nephron, ICI 207,828 appeared to act on both the thick ascending limb of the loop of Henle and the late distal nephron. In the toad bladder preparation, ICI 207,828 inhibited Na+ transport when placed on either the mucosal (amiloride-like) or serosal (thiazide-like or loop diuretic-like) sides. This compound also inhibited Cl- transport in the toad cornea preparation (loop diuretic-like). ICI 207,828 did not change plasma K+ significantly in dogs dosed for 14 days at doses having diuretic effects (5 and 10 mg/kg, p.o., daily). In contrast, HCTZ consistently decreased plasma K+, whereas amiloride increased it significantly. ICI 207,828 demonstrated antihypertensive effects in spontaneously hypertensive rats. At 30 mg/kg, p.o., b.i.d., ICI 207,828 and HCTZ produced approximately equal antihypertensive activities during a 3 1/2-day treatment period. The pharmacological profile of ICI 207,828 indicates that this compound is a potent eukalemic diuretic and antihypertensive agent in animals.

Amiloride↗
PubMed1991

Myocardial infarction and stroke during treatment of hypertensive patients with different diuretic regimes.

A retrospective analysis of mortality and cardiovascular morbidity in patients being treated with a potassium losing diuretic alone or the combination of a potassium losing and sparing diuretic was performed in 1,935 patients attending a hypertension clinic between 1971 and 1981. In all, 713 patients were treated with a potassium losing diuretic and 472 patients were on a potassium sparing diuretic, usually in combination with a potassium loser. Presenting data on risk factors were similar between the two groups and age-adjusted cardiovascular morbidity and mortality was similar between the two groups. The relative risk (RR) for a myocardial infarction event on a potassium losing drug was 1.1 (95% CI 0.5-2.3) in men and 1.0 (0.4-2.5) in women. The corresponding risks for stroke were 0.8 and 0.7 respectively and total mortality was 1.3 and 1.1. However, following exclusion of patients with previous history of cardiovascular disease the risk of myocardial infarction in the potassium losing group was over three times that on a sparing diuretic, though the confidence intervals were wide. Total male mortality tended to be higher (RR = 2.4) but again failed to achieve statistical significance. An excess risk from potassium losing diuretics was found only in patients without cardiovascular disease and cannot be readily explained. This may be the result of treatment selection in different 'at risk' groups or chance in the performance of subgroup analyses.

Cardiovascular Diseases↗
PubMed1990

[Hyperkalemia with potassium-sparing and potassium-losing diuretics. Results from the Comprehensive Hospital Drug Monitoring Bern (CHDM)].

Of 5047 in-patients in the Division of Internal Medicine, Zieglerspital Bern (regional/teaching hospital), admitted from 1982 to 1985, 2412 were treated with at least one diuretic. The hospital records of these patients were reviewed with regard in particular to serum potassium and creatinine values as well as potassium supplementation. On the basis of this evaluation the patients were assigned to 6 different treatment groups and the relative occurrence rate of hyperkalemia probably related to drug treatment was determined. Of the 590 patients treated with only potassium losing diuretics, none was found to show a hyperkalemia event; of the 742 patients on potassium losing diuretics and potassium supplementation, 27 (3.6%) developed hyperkalemia. In the 439 patients under combined diuretics (potassium sparing with potassium losing) without potassium substitution, 76 (17.3%), and in the 381 under combined diuretics with potassium substitution 24 (6.3%), developed hyperkalemia. The further groups of patients are also described. Renal function was estimated by the formula of Cockcroft and Gault. Reduced renal function is a significant risk-factor for hyperkalemic events under combined diuretics. All hyperkalemic events were within a serum potassium range of 5.1-7.0 mmol/l.

Creatinine↗
PubMed1989

Predicting acute gout in diuretic-treated hypertensive patients.

Factors predisposing to diuretic-induced acute gout were investigated in a case-control study. Seventy hypertensive patients with acute gout occurring during diuretic treatment were identified and matched for age and sex to 140 hypertensive controls who took diuretics but did not develop gout. Gout was related more strongly to the use of loop diuretics than thiazides, with 30% of cases taking a loop diuretic compared to 14% of controls (P less than 0.01). In a sub-group of men who took a thiazide and no other diuretic, gout was significantly associated with obesity (odds ratio 3.7, 95% confidence interval 1.4, 9.1) and high alcohol intake (odds ratio 3.3, 95% confidence interval 1.1, 9.8). In these patients, 23% of gout was attributable to obesity and 16% to high alcohol consumption. Approximately 40% of acute gout might have been prevented by avoiding thiazides in those 20% of men who weighed more than 90 kg and/or consumed more than 56 units of alcohol per week.

Acute Disease↗
PubMed1988

Methods for study of the effects of diuretics.

We live in an imperfect world, and no single technique of renal investigation has demonstrated a superiority in all aspects of diuretic research. We have tried to present a balanced view of the advantages and disadvantages of several of the most common techniques used to study diuretics. Because of space limitations, we have been unable to touch on important studies of diuretic effects on extrarenal tissues or even the effects of diuretics on nontransporting renal preparations (eg, metabolism in renal slices). There is still a time and a place for nearly all the techniques summarized here in the study of diuretics and their impact on renal physiology. It is our hope that this brief introduction into renal methodology will allow the discerning reader of studies of diuretics to decide for himself whether the tools chosen by the investigator were appropriate to answer the questions posed, and if not, how the questions may be more properly addressed. It is important to remember that data are neither right nor wrong; the results exist and cannot be otherwise. However, our interpretation of the data may be wrong, and the most important aspect of any experiment is not the technique but the thought behind it.

Animals↗
PubMed1987

Urinary prostaglandin E2 excretion, sodium retention, and diuretic responsiveness in patients with chronic liver disease.

It has been postulated that diminished renal prostaglandin E2 (PGE2) production, whether basal or in response to stimulation by diuretic treatment, determines the intensity of sodium retention in cirrhosis. Urinary PGE2 excretion (as an index of renal PGE2 production) as well as urine volume, urinary sodium and potassium excretion, and creatinine clearance were examined in 19 patients with cirrhosis and either no ascites, diuretic-responsive ascites, or diuretic-resistant ascites. Measurements were made both before (all patients) and after (ascitic patients) stimulation of renal PGE2 synthesis by 80 mg of furosemide intravenously. Urinary PGE2 excretion was similar in the three groups both before and after furosemide. Baseline urine volume and creatinine clearance were similar in all groups but were significantly less after furosemide in patients with diuretic-resistant ascites as compared to the other two groups. The natriuretic response to intravenous furosemide was significantly less in patients with diuretic-resistant ascites. Insertion of the peritoneovenous shunt to aid in the management of diuretic-resistant ascites resulted in a marked, immediate increase in urine volume and urinary PGE2 excretion in the four patients who were serially evaluated, but natriuresis occurred in only two. Overall, urinary PGE2 excretion correlated with urine volume but not with sodium excretion or creatinine clearance. Diminished renal PGE2 production, as reflected by urinary PGE2 excretion, does not appear to be a determinant of the severity of renal sodium retention in cirrhosis.

Chronic Disease↗
PubMed1986

[Diuretics].

Microaspiration techniques and clearance studies have shown that reabsorption of filtered sodium approximates 65% in the proximal tubule, 25 to 30% in the ascending limb of the loop of Henle and 5 to 10% in the dilution segment. Reabsorption in the Henle loop is of special significance as it governs the process of dilution-concentration of urine. Moreover, inhibition of sodium reabsorption in the loop of Henle necessarily produces a substantial loss of sodium since only a fairly small fraction of urinary sodium is reabsorbed beyond the Henle loop (dilution segment, distal tubule). Excretion of water and electrolytes is regulated by humoral factors, such as the renin-angiotensin-aldosterone system, some prostaglandins and certain kinins. Factors that promote excretion of sodium, produced in particular by the myocardium, have recently been demonstrated. The correlation between blood pressure and salt has been substantiated by many findings. Diuretics are commonly used to treat high blood pressure as well as edema. Recent evidence indicates that sodium transport is altered in idiopathic hypertension, at least in red blood cells. Clinical trials of diuretics are designed to localize the drug's action and quantify its saluretic activity (evaluation of potency and effectiveness--single doses, sustained treatment). Furthermore, the minimal efficient antihypertensive dosage should be determined. Diuretics can be divided into two groups according to whether they produce an increase or decrease in serum potassium. Diuretics that are capable of producing hypokalemia belong to two main families. One consists of the Henle loop diuretics that interfere with the mechanisms of dilution-concentration of urine. Action of these drugs is potent and short-lived. For instance, following a single dose of furosemide, excretion of sodium can reach 25-30% of filtered sodium; renal blood flow increases; CH2O and TCH2O decrease. With furosemide, induction of diuresis is rapid (within a few minutes after IV injection and 20 mn after oral ingestion); elimination half-life is 50 mn; absolute bioavailability is 50-70%; 95% of the drug is bound to plasma proteins; elimination is mainly through the kidneys. Other Henle loop diuretics include ethacrynic acid, whose elimination half-life is less than one hour; bumetanide, which is 40 times more potent than furosemide; muzolimine, whose action is more lasting despite the fact that only 65% of the drug is bound to plasma proteins; and ozolinone, which has a saliuretic action comparable to that of furosemide and in addition exerts a direct vasodilating effect.(ABSTRACT TRUNCATED AT 400 WORDS)

Acid-Base Equilibrium↗
PubMed1985

Clinical efficacy and safety of long-term diuretic treatment in renal parenchymal hypertension.

In 48 patients with early stage renal disease and mild to moderate hypertension, control of high blood pressure and metabolic alterations during long-term diuretic treatment (mean duration, 71 months) were assessed. Compared to the untreated state, administration of thiazide-potassium sparing diuretics, a single table per day, supplemented by dietary sodium restriction, led to normalization of high blood pressure. Renal function was preserved. Gross abnormalities in electrolyte metabolism did not occur. Deterioration of glucose tolerance was noted in 3 patients. Preexisting hyperlipidemia was aggravated by the diuretics in men and postmenopausal women, but premenopausal women were protected. Long-term diuretic treatment was well tolerated, and caused remarkably few significant untoward reactions. The unfavorable metabolic response to diuretic treatment may, however, cancel part of the potential benefit of blood pressure control in certain patients. During long-term diuretic treatment of renal patients, attention should be given to monitoring of metabolic parameters and the introduction of specific dietary treatment may become the cornerstone of patient management.

Adult↗