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 883 records · Page 49Linked to original sources
PubMed1992

Sodium, large arteries and diuretic compounds in hypertension.

BACKGROUND: Clinical and experimental data have shown that different antihypertensive drugs do not cause similar changes in arterial compliance for an equipotent blood pressure reduction. There are no clear data on the effects of sodium and diuretics on the visco-elastic properties of the hypertensive arterial wall. DATA ANALYSIS: Cross-sectional epidemiological studies suggest that for given values of age and blood pressure, pulse wave velocity is lower in the presence than in the absence of a low sodium intake. Longitudinal studies indicate that in hypertensive subjects, a low sodium intake is associated with a larger brachial artery diameter than that seen with a high sodium intake. In hypertension in the elderly and in severe hypertension with end-stage renal disease, a sodium overload reduces arterial compliance and distensibility independently of blood pressure changes. In animal studies, the diuretic compounds cycletanine and indapamide increase systemic and carotid compliance independently of blood pressure changes. In contrast, in a crossover study in hypertensive subjects, the diuretic agent hydrochlorothiazide did not change arterial compliance and pulse wave velocity while the calcium entry-blocker felodipine did improve these hemodynamic parameters. CONCLUSION: The studies reviewed indicate that sodium may act on the arterial wall independently of blood pressure changes. the contribution made by counter-regulatory mechanisms, which may be related to the renin-angiotensin and the sympathetic nervous systems, might explain the differences between the clinical and the experimental changes observed with diuretic compounds.

Animals↗
PubMed1992

[Loop diuretics and the treatment of asthma].

Current data in the literature show a protective effect of loop diuretics in relation to certain types of experimental bronchospasm. This action has sometimes been observed after the administration of diuretics as aerosols in less severe cases of asthma. The initial observations on bronchospasm induced by physical stimuli (exercise, distilled water and hyperventilation), have been extended to bronchospasm provoked by allergens or certain chemical stimuli (metabisulphide, adenosine 5'-monophosphate, and salicylic acid). On the other hand provocation tests using histamine or acetylcholine are modified, either a little or not at all by diuretics. The proposed mechanisms of action are multiple, but are still very hypothetical: an action on ionic fluxes in the epithelial cells, in mastocytes, in nerve cells and in muscle cells inducing the secretion of prostaglandin. Diuretics certainly have opened some interesting patho-physiological approaches, but current data concerning their efficacy in asthmatics are still fragmentary and do not, at the current time, allow them to take a significant place in the therapeutic arsenal of asthma drugs.

Administration, Inhalation↗
PubMed1992

[Effect of diuretics on serum lipoproteins].

UNLABELLED: BASICS: Drug treatment of the risk factor hypertension has not led to the expected reduction in morbidity and mortality of coronary arterial disease. A negative effect of antihypertensive drugs on the lipid metabolism is under discussion as a possible cause. MAIN TOPICS: Both the commonly employed thiazide diuretics and chlorthalidone and the loop diuretics furosemide, piretanide and xipamide lead, to varying extents, to an increase in total and LDL cholesterol as well as triglycerides in subjects with normal metabolism. In addition, some diuretics lower the levels of protective HDL cholesterol. These side effects can be avoided--at least in part--by a combination with such drugs as prazosin, pindolol or captopril, which have a favorable effect on metabolism. CONCLUSION: It is recommended to carefully monitor serum Lipoproteins during diuretic treatment so that possible adverse changes may be counteracted by appropriate measures.

Arteriosclerosis↗
PubMed2005

Effect of the diuretic furosemide on urinary essential nutrient loss and on body stores in growing rats.

Studies using a model of non-infectious diarrhea, have shown that increasing fecal mass by using laxatives resulted in greater fecal losses of nutrients and lower intestinal absorption. In the present study we used a diuretic to determine if increasing urine volume could result in greater urinary losses of essential nutrients. This is a relevant question because diuretics are widely and successfully used in the treatment of diseases associated with water retention and hypertension. They are known to increase potassium losses. However, there is less information on the effect of diuretics on the urinary losses of essential nutrients. Accordingly, urinary nitrogen, phosphorous, sodium, potassium, magnesium, zinc and retinol were measured in young rats consuming increasing concentrations of furosemide (0, 0.5, 1.0, 1.5 mg/g diet) in the diet over 15 days. The results showed that dietary furosemide caused a dose-dependent polyuria. In addition it reduced food intake and feed efficiency and leaded to poor growth and greater urinary losses of all the measured nutrients and electrolytes. These losses were proportional to urine volume and represented an important fraction of the rats daily intake. The losses were negatively associated with the body and liver content of the same electrolytes and nutrients. In general, this study showed that the diuretic furosemide caused malnutrition in a short period of time by reducing food intake as well as the capacity of retaining macro and micronutrients including the liposoluble vitamin A in a relatively short period of time. This study, together with our previous studies on diarrhea, indicate that proper nutrient utilization requires both an adequate intestinal and renal function.

Absorption↗
PubMedDate not supplied

[Use of diuretics in congestive heart failure: renal effects].

Diuretics are an integral part of the management of symptomatic heart failure. Although they have been used for several decades, there is still some ambiguity and confusion regarding the outcome and the optimal way of using these common agents. There are no large-scale randomized controlled trials that have evaluated the effect of diuretics on mortality and long-term morbidity in diastolic and systolic dysfunction. Nonetheless, in short-term studies furosemide has demonstrated to reduce symptomatic congestive heart failure and hospitalization, and to improve exercise capacity in the setting of systolic dysfunction. In this review, the classes, sites of action and renal effect of diuretics are reviewed and the various indications, optimal doses and recommendations on effective use and disuse are discussed. Namely, this review addresses the effects of emerging diuretic agents such as eplerenone--a selective mineral corticoid receptor antagonist, nesiritide--a brain natriuretic peptide-recombinant, and conivaptan--a vasopressin antagonist, in attempt to provide an update on current knowledge, even though adequate clinic data are not available for all agents.

Diuretics↗
PubMedDate not supplied

[The influence of inhibitors of kinin and prostaglandin formation on the vascular and tubular effects of osmotic diuretics in the kidney].

Mannit was shown to increase the blood flow in the external, middle and internal zone of the renal cortex in anesthetized rats but exerts no effect on the blood supply to the external zone of the medullary layer. A preliminary administration of contrykal fails to influence the diuretic and natriuretic effects of the preparation and to change the character of the hemodynamic shift at the action of the diuretic in the middle zone of the cortical layer. Indomethacin completely eliminates the blood flow increase in the middle zone of the cortex but it does not prevent the diuretic and natriuretic reaction to mannit administration. It is concluded that realization of the vascular and tubular effects of the diuretic is not related to the increase of kinin biosynthesis in the kidneys. Prostaglandins formed in the kidneys under the influence of mannit are involved in the mechanism of dilatation of the vessels of the cortical layer but do not play the significant role in the formation of its tubular effect.

Animals↗
PubMedDate not supplied

Acute antihypertensive, diuretic and metabolic effects of etozolin and chlorthalidone.

Etozolin, a new diuretic agent, has shown a dose-dependent diuretic and saluretic effect in both experimental and clinical studies. Etoxolin, when compared to furosemide or thiazides, exerts a similar effect on urinary excretion of water and Na+, but induces a lower urinary K+ and Cl- excretion and a smaller activation of the renin-angiotensin-aldosterone system. Furthermore, the E series of the prostaglandin system seems to play a role in the mechanism of action of the drug. Seven uncomplicated hypertensive patients were included in this double blind, placebo controlled study, according to a latin square design. Each patient received three single oral doses of etozolin (200 mg, 400 mg, 600 mg), of chlorthalidone (25 mg, 50 mg, 75 mg) and one dose of placebo. Etozolin and chlorthalidone caused a similar, dose-dependent antihypertensive and diuretic effect. However, several haemodynamic and metabolic differences were observed between the two drugs. Etozolin, unlike chlorthalidone, caused no increase of heart rate, no decrease of serum K+ levels and a marked rise plasma PGE2. Moreover, etozolin caused a significantly smaller decrease of serum Na levels compared to chlorthalidone, and a significantly lower increase of supine and standing PRA, of plasma aldosterone and of the urinary excretion of Na and K. These results confirm that the acute antihypertensive and diuretic activity of etozolin occur with little involvement of the RAA system and with a significant but still unclear activation of the prostaglandin system.

Antihypertensive Agents↗
PubMed1991

Diuretics, hypochloremia, and outcome in bronchopulmonary dysplasia patients.

We evaluated retrospectively the outcome of patients with severe bronchopulmonary dysplasia who required hospitalization (greater than 90 days) to determine the role of diuretics aminophylline and chloride deficiency in the fatal outcome of these patients. Total cumulative amounts of furosemide, chlorothiazide, spironolactone accrued during hospitalization (dosage per patient per day), and a diuretic index (logarithm of the sum of the cumulative dosage of the three diuretics) were calculated for each patient. Other predetermined variables included in the analysis were birth weight, gestational age, duration of mechanical ventilation, duration of oxygen therapy, caloric intake, fluid and electrolyte intake, echocardiographic data, and duration and type of acid base balance disturbances. No differences were found between survivors and nonsurvivors in diuretic and aminophylline use. Hypochloremia did not discriminate between the groups. Duration of mechanical ventilation, the ratio between days with serum bicarbonate concentration greater than 30 mEq/l and total days of hospitalization, and the difference between head circumference at discharge or death and birth head circumferences were the most important factors which contribute to the difference between survivors and non survivors.

Acid-Base Imbalance↗
PubMed1991

[Diuretics in arterial hypertension: a firm commitment for the 90's?].

A clinical pharmacology review of thiazide diuretics is presented in this paper, highlighting the mechanism of action, dosage considerations in order to optimize both the monotherapy or combination treatment, most relevant metabolic effects and adverse reactions, and clinically significant drug interactions. Reference is made to several attemps of limiting or reducing the popularity of their use which took place in mid eighties. At present, there are no data to substantiate that diuretics are implicated for the lack of a consistent reduction in coronary heart disease events. As a consequence of the renewed interest in the development of drugs with diuretic antihypertensive action, the physiologic changes associated with the use of indapamide have been briefly characterized. This agent is also perceived as having more favourable neutral metabolic profile at subnatriuretic dosage. After careful consideration of relevant scientific evidence and a critical appraisal of individualized approach to antihypertensive therapy, diuretics should be given serious consideration as valid alternative to modern antihypertensive agents in years to come.

Diuretics↗
PubMed1990

Diuretic and hypotensive activities of 4-anilino derivatives of 2-methylthiopyrido[2,3-d]pyrimidines.

The synthesis of a series of 12 compounds referring to 4-anilino-2-methylthiopyrido [2,3-d]pyrimidines (1-12), and the results of a study of their diuretic, saliuretic and antihypertensive activities are reported. Most of this compounds showed significant diuretic activity at the dosage of 3-24 mg/kg. The 4-Anilino-2-methylthiopirido[2,3-d]pyrimidine 1 remained active to a dosage of 1 mg/kg. The diuretic activity of these compounds implied an increase in the Na+ excretion. Some of the most active diuretics have been studied for antihypertensive effect.

Aniline Compounds↗
PubMed1990

Effect of diuretic and antidiuretic agents on lithium clearance as a marker for proximal delivery.

Diuretic drugs have marked effects on lithium clearance. The magnitude and mechanism of the effect depend not only on the site of action of the diuretic but also on the sodium intake of the subject as well. In sodium restricted rats all diuretics except the thiazides increase FeLi and abolish distal lithium uptake. The increase in FeLi produced by proximal and loop diuretics are associated with changes in proximal delivery. Amiloride, on the other hand, increases FeLi solely through inhibition of distal lithium uptake. Therefore, this agent is useful to detect lithium reabsorption beyond the proximal tubule. Additionally the values for FeLi obtained after amiloride administration may provide the best quantitative estimate for proximal delivery in conditions where distal lithium uptake is a consideration. Antidiuretic agents, especially those which potentiate ADH activity, may also have marked effects on lithium clearance. NSAID's and dDAVP are able to significantly reduce FeLi even in sodium loaded animals. As this occurs without a change in proximal delivery, these agents increase lithium reabsorption in distal nephron segments preferentially. Thus, estimates of proximal delivery determined by lithium clearance are not valid in the presence of these agents. Experimental conditions which produce high levels of endogenous ADH or potentiate the action of endogenous ADH may also adversely effect FeLi as a quantitative marker for proximal delivery. Whether there are other drugs which disrupt the ability of lithium clearance to function as a marker for proximal delivery requires further study.

Animals↗
PubMed1990

[The treatment of ankle edema in the elderly in family practice; when and how often are diuretics used?].

It has long been recommended that one should be careful in prescribing drugs for the elderly. However, it has been shown that more than 20% of those over 65 use diuretics. With advancing age this percentage increases. The sign of ankle oedema appears to be an important factor in the decision to prescribe diuretics. If the oedema is not caused by heart failure, chronic renal failure or hypoproteinaemia, the use of diuretics in ankle oedema is controversial. We used a questionnaire survey to obtain information on the opinions of Dutch general practitioners about the differential diagnosis and treatment of ankle oedema in the elderly. In the questionnaire we presented the case of a 68-year-old woman who complained of ankle oedema without any symptom or sign of heart failure. The questionnaire was sent to 200 Dutch general practitioners (response rate 64%). Chronic venous insufficiency was mentioned by 86% and heart failure by 12% of the responders as the most probable cause of the oedema. The treatment proposed by 59% was advice and (or) compression therapy without drugs, while 40% would have prescribed diuretics.

Aged↗
PubMedDate not supplied

[Use of diuretics in the treatment of ascites in patients with cirrhosis].

The cirrhotic patient with ascites has an increased tubular reabsorption of sodium. Diuretic therapy allows an urinary loss of sodium. The strongest diuretics which inhibit sodium reabsorption in the ascending limb of the loop of Henle (like furosemide) are not the most effective in cirrhotic patients; indeed the increased load of sodium arriving in the distal part of the tubule is reabsorbed because of hyperaldosteronism. Potassium-sparing diuretics, like spironolactone, which act beyond the sites of reabsorption of most of the filtered sodium, are mostly effective when combined with other diuretics which impair sodium reabsorption more proximally. We propose to treat ascites by: 1. Sodium restriction (maximum: 60 mmol per day); 2. Spironolactone 100 to 500 mg per day, combined with furosemide 40 to 200 mg per day if spironolactone does not induce a natriuretic effect.

Ascites↗
PubMed1990

ACE inhibitors and diuretics causing hypokalaemia.

Angiotensin-converting enzyme (ACE) inhibitors and diuretics are known to cause hyperkalaemia. We undertook a prospective analysis over a period of six months of patients admitted under our care. Of 217 patients, 39 (18 per cent) were admitted with congestive cardiac failure/left ventricular failure. Of these 39 patients, 21 (54 per cent) were prescribed ACE inhibitors. Seven of these 21 patients subsequently developed hypokalaemia. This was irrespective of the type or dose of the diuretic but seemed to be related to the dose of the ACE inhibitor. In three cases the hypokalaemia was corrected by the addition of a potassium-sparing diuretic; in two cases a potassium supplement was added; and in the other three an increase in the dose of the ACE inhibitor for the resistant heart failure corrected the potassium deficit. This study shows that one should be alert to both hyperkalaemia and hypokalaemia when using a combination of ACE inhibitors and diuretics.

Aged↗
PubMed1990

Effect of diuretic use on the development of diabetes mellitus. The Framingham study.

The hypothesis that diuretic use may increase the risk of diabetes mellitus was prospectively examined in men and women aged 50 years and over in the Framingham study. Age-adjusted relative risk estimates were calculated comparing the rate of diabetes among those who took diuretics to those who did not take these medications. The relative risks (95% confidence limits) were statistically elevated (P less than 0.05) in both sexes; 2.1 (1.2, 3.6) in men and 2.5 (1.4, 4.5) in women. After covariate adjustment for body mass index, concentrations of total cholesterol, high density lipoprotein cholesterol, very low density cholesterol, systolic blood pressure, and cigarette smoking the relative risks were no longer statistically significant; 1.2 (0.6, 2.4) for men and 1.6 (0.8, 3.2) for women. These results are suggestive of a possible deleterious affect of diuretic use particularly in women and indicate that persons receiving diuretic agents should be carefully monitored for adverse changes in other risk factors.

Diabetes Mellitus↗
PubMed1986

Fluid and electrolyte considerations in diuretic therapy for hypertensive patients with chronic obstructive pulmonary disease.

When a patient with chronic obstructive pulmonary disease (COPD) requires medical therapy for systemic hypertension, a number of special considerations may affect the choice of antihypertensive drug and subsequent management. Thiazide diuretics have no adverse effect on airway function and are the agents of choice for initial therapy. beta-Antagonists are usually considered first-line agents in antihypertensive therapy, but even relatively cardioselective ones may increase airway resistance in patients with obstructive lung diseases, and they should be used with caution, if at all, in such patients. Although potassium-wasting diuretics are the preferred agents for treating hypertension in patients with COPD, they may worsen carbon dioxide retention in hypoventilating patients and potentiate hypokalemia in those receiving corticosteroids. In addition, beta-agonists may substantially lower serum potassium levels in patients already rendered hypokalemic by diuretics. Patients with COPD receiving potassium-wasting diuretics who have chronic respiratory acidosis or are receiving corticosteroids or beta-agonists should undergo close monitoring of electrolyte levels and be considered for therapy with potassium supplements or, preferably, potassium-sparing agents.

Adrenal Cortex Hormones↗
PubMed1977

An optimal diuretic regimen for cirrhotic ascites. A controlled trial evaluating safety and efficacy of spironolactone and furosemide.

Previous studies demonstrated the effectiveness of diuretics in mobilizing fluid, but frequent complications occur with their use in treating ascites. To develop an effective but safe regimen for treatment of cirrhotic ascites, a two-part crossover study was done. Subjects with life-threatening complications of cirrhosis were excluded. In part one it was demonstrated that a six-day diuretic regimen with dietary sodium restriction of 10 mEq/day is safe and more effective than sodium restriction alone. In part two the duration of diuretic therapy was safely extended from six to nine days with mobilization of significantly more fluid. Careful selection of subjects, use of diuretics in modest dosages for brief periods of time, and daily monitoring of subjects were important for the success of this study.

Ascites↗
PubMed1987

Diuretics, hypokalaemia and arrhythmias in hypertensive patients: still an unresolved problem.

Hypokalaemia in man is associated with an increased incidence of cardiac arrhythmias. Thiazide diuretics cause hypokalaemia in a proportion of otherwise healthy hypertensive patients, and there is a risk that in these patients hypokalaemia induced by diuretics may initiate serious cardiac arrhythmias and even sudden death. The data suggest that such circumstances are rare and a study designed to demonstrate an effect on mortality would need to be larger than any reported or current trial. Diuretic-induced hypokalaemia may account for some of the small differences in mortality from heart disease that have been reported in subgroups of patients from recent trials aimed at the prevention of coronary heart disease or treatment of hypertension. There are several therapeutic regimens by which diuretic-induced hypokalaemia may be detected, treated or prevented. Most physicians already take heed of this problem so that it is no longer a major therapeutic issue.

Arrhythmias, Cardiac↗