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PubMed1993

The place of diuretics in the treatment of hypertension in 1993: can we do better?

Diuretics are the only class of antihypertensive drugs that have been conclusively shown to reduce morbidity and mortality in long term outcome trials. However even in these trials there were difficulties with withdrawals, cross contamination, high usage of 2 or more drugs and adverse effects. Low doses of thiazide diuretics should be recommended because they have equal blood pressure lowering effects with less biochemical changes and adverse reactions. In 3 of the 4 outcome trials in the elderly in which there were significant reductions in cardiovascular morbidity and mortality a potassium sparing agent was used in conjunction with the thiazide diuretic, raising the possibility of additional cardioprotection.

Aged↗
PubMed1995

Thiazide diuretics induce cutaneous lupus-like adverse reaction.

One of the side effects reported in patients taking thiazide diuretics is photosensitivity. We report two patients who developed lupus-like skin lesions while taking thiazide diuretics. One patient developed erythematous scaling papules, patches and plaques on the upper extremities and trunk resembling subacute cutaneous lupus erythematosus. Histopathology of a skin biopsy from the trunk showed basal cell layer liquefaction and lichenoid interface changes suggestive of lupus erythematosus. The skin lesions resolved completely within two months of discontinuing thiazide therapy. The second patient developed multiple flesh colored urticarial plaques on the trunk one year after beginning thiazide therapy. Slight lichenoid interface changes were noted on a skin biopsy, along with dense mucin deposition in the papillary and deep dermis, suggestive of tumid lupus erythematosus. The skin lesions persisted despite discontinuing thiazide therapy, necessitating systemic corticosteroid treatment. Both patients had circulating anti-SSA/Ro autoantibodies and antinuclear antibodies. These two patients illustrate that thiazide diuretics may induce a cutaneous lupus erythematosus-like adverse reaction and production of anti-SSA/Ro autoantibodies as demonstrated by immunodiffusion, immunoblot and immunoprecipitation testing.

Aged↗
PubMed1997

Determination of dissociation constants of loop diuretics in acetonitrile-water mixtures.

The dissociation pK values of the representative loop diuretics furosemide, bumetanide and ethacrynic acid in 10, 30, 40, 50 and 70% (w/w) acetonitrile-water mixtures at 298.15 K were determined, according to the rules and procedures endorsed by IUPAC. The variation in pK values over the whole composition range studied can be explained by tacking into account the preferential solvation of ionizable substances in acetonitrile-water mixtures. With a view to determining the pK values of the loop diuretics studied in any of the binary solvent acetonitrile-water mixtures, correlations of pK values and different bulk properties of the solvent were examined, and the linear solvation energy relationships method, LSER, has been applied. The pK values were then correlated with the pi*, alpha and beta solvatochromic parameters of acetonitrile-water mixtures. The resulting equations allowed us to calculate pK values for the loop diuretics in any acetonitrile-water mixture up to 70% (w/w) acetonitrile.

Acetonitriles↗
PubMed2002

Diuretic effect of sodium artesunate in patients with malaria.

Previously, we described a direct inhibitory effect of sodium artesunate on sodium chloride transport in the thick ascending limb of Henle's loop, indicating that artesunate acts as a diuretic agent. Here we present 2 cases of falciparum malaria treated with 4 intravenous 60-mg doses of sodium artesunate. Neither diuretics nor vasoactive drugs were administered. A rise in diuresis (6 L/24 hours) was accompanied by an increase in natriuresis, and both declined at the end of the treatment. This diuretic effect has not been reported previously in patients and may modify the course of renal failure and respiratory distress syndrome, both of which complicate severe malaria.

Adolescent↗
PubMed1975

Sodium restriction and thiazide diuretics in the treatment of hypertension.

In a group of hypertensive patients it has been shown that moderate sodium chloride restriction has a hypotensive effect that is similar to that produced by thiazide diuretics. Blood pressure changed in relation to body weight in individual patients, and appeared to correlate with their sodium balance. The more a patient was depleted of sodium, the lower was the blood pressure. The serum potassium level fell with the use of thiazide diuretics, but in this group of patients there was little change in total body potassium content. The fall in serum potassium level appeared to relate to a shift into the cells due to the accompanying alkalosis. Potassium supplementation appeared to have had little effect and was unnecessary for most patients who were given diuretics for hypertension. Amiloride corrected the alkalosis and restored the serum potassium level to normal.

Amiloride↗
PubMed1993

Psychotropics, thiazide diuretics and hip fractures in the elderly.

OBJECTIVE: To determine whether psychotropic medications increase, and thiazide diuretics decrease, the risk of hip fractures in elderly Australians. DESIGN: Population-based case-control study. SUBJECTS AND SETTING: The population aged 65 years and over living in a defined area in western Sydney, Australia, during 1990-1991. Cases (n = 209) were recruited from hospitals and controls (n = 207) were selected by an area probability sampling method, with additional sampling from nursing homes. Response rates were 96% for cases and 84% for controls. MEASURES: Data were collected directly from subjects by questionnaire; a proxy respondent was required for 27% of subjects. In addition to medication use, information was also collected on potential confounders: alcohol consumption, body mass index, cognitive status, dairy product consumption, health status, physical activity, smoking history and type of residence. RESULTS: The use of temazepam, a short-acting benzodiazepine, was associated with an increase in the risk of hip fracture--odds ratio, adjusted for age, gender and residence is 3.78; 95% confidence interval (CI), 1.60-8.92. After adjusting for multiple potential confounders by logistic regression, the odds ratio for temazepam use was 3.52. There was a non-significant (P > 0.05) increase in hip fracture risk associated with the use of antidepressants and antipsychotics. Thiazide diuretics were not associated with a risk of hip fracture--the multivariate-adjusted odds ratio was 0.98 (95% CI, 0.49-1.99). CONCLUSIONS: Temazepam may increase the risk of hip fracture in elderly people. The effect of thiazide diuretics on fracture risk should be assessed in a large randomised trial.

Aged↗
PubMed1978

[Role of diuretics in arterial hypertension].

The place of diuretics in the treatment of hypertension (HT) no longer requires to be proved, but their mode of action remains uncertain. Blood volume measurements allow us to distinguish the cases of HT which are volume-dependent, and which constitute the major indication for this type of treatment. The various groups of diuretics have a specific action on the renal tubule, but may all lead to complications, which imply that their use should be rational and that biochemical follow-up should be close when they are administered for a prolonged period. Used singly, diuretics effectively suppress HT in 40 per cent of cases, and when used in association with a beta-blocker, they produce normal blood pressure in 70 per cent of cases.

Animals↗
PubMedDate not supplied

Erythrocyte osmotic fragility in hypertension and during diuretic therapy.

To determine the effect of diuretic therapy on osmotic fragility of red blood cells of hypertensive patients, 25 hypertensive and 15 normotensive subjects were followed up for 12 weeks. Osmotic fragility of erythrocytes of the hypertensive subjects were determined before treatment and at 6 weeks and 12 weeks after the start of diuretic therapy. The red cell size was larger in hypertensive subjects than in normal controls. With treatment, however, the red cell size was similar in the two groups of subjects. Osmotic fragility was higher in hypertensive subjects than in normotensive subjects. The osmotic fragility also became similar in the two groups with control of blood pressure in the hypertensive group. Osmotic fragility of red blood cells may be determined as a screening tool for hypertensive patients who will benefit from diuretic therapy.

Case-Control Studies↗
PubMed1999

Diuretics: correct use in hypertension.

The use of diuretics for the treatment of hypertension had fallen significantly from 1990 until 1997, when their use again began to increase. Their recent return to popularity reflects 3 major factors: (1) the recognition of the effectiveness of much lower doses than used previously, thereby providing good antihypertensive action with fewer side effects; (2) the excellent reductions in morbidity and mortality achieved by low-dose diuretic-based therapy in multiple, randomized controlled trials in elderly hypertensives; and (3) the increasing recognition that some diuretic-induced shrinkage of effective blood volume is essential for adequate treatment of many, if not most, hypertensives.

Controlled Clinical Trials as Topic↗
PubMed2000

Effects of the V(2)-receptor antagonist OPC-41061 and the loop diuretic furosemide alone and in combination in rats.

This study was conducted to characterize the diuretic effect of OPC-41061, a nonpeptide vasopressin V(2)-receptor antagonist, and furosemide by administering each alone and in combination in conscious male rats. OPC-41061 at 1 and 10 mg/kg and furosemide at 10 and 100 mg/kg dose-dependently increased urine volume to the same extent. The high dose of OPC-41061 (10 mg/kg) markedly elevated electrolyte-free water clearance (E-CH(2)o) to a positive value. In contrast to OPC-41061, furosemide elevated only electrolyte clearance but not E-CH(2)o. The differences in diuretic profile reflected the changes in serum sodium and hormone levels. OPC-41061 dose-dependently elevated serum sodium concentration, but furosemide tended to decrease it. The high dose of furosemide (100 mg/kg) significantly elevated serum renin activity and aldosterone concentration, indicating that furosemide activated the renin-angiotensin-aldosterone system (RAA-system). On the other hand, OPC-41061 did not affect these parameters. When OPC-41061 was administered concomitantly with furosemide, OPC-41061 significantly increased urine volume and E-CH(2)o, and decreased urinary osmolality compared with furosemide alone. OPC-41061 dose-dependently elevated serum osmolality and sodium concentration even when administered in combination with the high dose of furosemide. These results suggest that OPC-41061 produces aquaresis leading to increased serum sodium without affecting the RAA-system. On the other hand, furosemide produced natriuresis, leading to decreased serum sodium level and activation of the RAA-system. It was also demonstrated that OPC-41061 produced an additive diuretic effect and elevated serum sodium level in the presence of furosemide.

Aldosterone↗
PubMed1976

Diuretics in malignant effusions and edemas of generalized cancer.

Forty patients with generalized cancer complicated by water and electrolyte retention were treated with "medium" and "large" doses of furosemide and bumetanide with 35% and 40% objective positive response, respectively. A smaller percentage of patients benefited from these diuretics, mainly in the quality of their lives. Peaks" of diuresis lasting a few days were observed in positive diuretic response. It is therefore concluded that diuretics may be more effective in malignant conditions if administered in a "high-dose pulse" therapeutic schedule.

Ascites↗
PubMed2000

Prolonged exercise following diuretic-induced hypohydration: effects on cardiovascular and thermal strain.

To examine the role of a reduction in plasma volume (PV) on the cardiovascular and thermoregulatory responses to submaximal exercise, ten untrained males (VO2 peak = 3.96 +/- 0.14 L x min(-1); mean +/- SE) performed 60 min of cycle exercise at -61% of VO2 peak while on a diuretic (DIU) and under control (CON) conditions. Participants consumed either Novotriamazide (100 mg triameterene + 50 mg hydrochlorothiazide, a diuretic) or a placebo, in random order, for 4 days prior to the exercise. Diuretic resulted in a calculated 14.6% reduction (P < 0.05) in resting PV. Heart rate was higher (P < 0.05) at rest and throughout exercise for DIU compared with CON. No differences were observed for cardiac output (Qc) and stroke volume (SV) at rest for the two conditions, but during exercise both Qc and SV were lower (P < 0.05) with DIU. Exercise VO2 (L x min(-1)) for CON and DIU at 30 min (2.39 +/- 0.09 vs 2.43 +/- 0.08) and 60 min (2.56 +/- 0.08 vs 2.53 +/- 0.12) were similar between conditions. Whole body a-vO2 difference was significantly greater (P < 0.05) for DIU both at rest and during exercise as compared with CON. Rectal temperature (Tre) was significantly higher (P < 0.05) during DIU from 15 min to the end of exercise. Blood concentrations of norepinephrine were higher (P < 0.05) with DIU compared to CON at 15 min of exercise and beyond. For blood epinephrine, no differences were observed between DIU and CON. These results suggest that reductions in PV led to greater circulating concentrations of norepinephrine which likely resulted from increased cardiac and thermoregulatory stresses. In addition, reductions in PV do not appear to increase cardiovascular instability during prolonged dynamic exercise.

Adult↗
PubMed2001

[Are the newer antihypertensive agents better and more effective than diuretics?].

BACKGROUND: In recent years, the expenses for medical antihypertensive therapy have increased considerably, the main reason being the switchover to newer and more expensive antihypertensive drugs. RESULTS: Several recent studies which have compared the efficacy of the older, conventional drugs (thiazid diuretics and beta-blockers) with the newer agents (calcium blockers, angiotensin-converting enzyme (ACE) inhibitors), have shown that they are almost equipotent with regard to effects on blood pressure, morbidity and mortality. At lower doses, the metabolic effects of thiazide diuretics are minimal and probably without clinical significance, and the risk of developing diabetes mellitus type 2 does not seem to be increased. INTERPRETATION: The cheaper thiazide diuretics are still valuable drugs in the treatment of hypertension. If more than one agent is necessary to reduce blood pressure to the desired level, they can be combined with other antihypertensive agents.

Adrenergic beta-Antagonists↗
PubMed2001

Mimicry of surreptitious diuretic ingestion and the ability to make a genetic diagnosis.

Gitelman's syndrome, also known as "hypocalciuric variant of Bartter's syndrome", is a cause of chronic hypokalemia and hypomagnesemia in adults. A specific gene has been found responsible for this disorder, encoding the thiazide-sensitive NaCl coporter (TSC) in the distal convoluted tubule. We describe a psychiatric patient with chronic symptomatic hypokalemia and hypomagnesemia whose electrolyte disturbances were subsequently misdiagnosed as an acute alcohol and benzodiazepine withdrawal syndrome, as chronic diuretic abuse and as a classical Bartter's syndrome. Finally, genetic investigation revealed the presence of mutations in the SLC12A3 gene leading to the proper diagnosis of Gitelman's syndrome. We emphasize that Gitelman's syndrome should be suspected in every hypokalemic patient with biochemical resemblance of diuretic ingestion, especially when repeated toxic screens for diuretics are negative. The ability to make a molecular-genetic diagnosis can be of practical benefit in confusing clinical settings.

Adult↗
PubMed1975

Diuretics.

The use of diuretics to treat edema is reviewed. Normal salt and water metabolism is reviewed briefly. The drugs covered are the thiazide diuretics, loop diuretics(ethacrynic acid and furosemide) and distal blocking agents (spironolactone and triamterene). The sites and modes of action, indications, doses, complications and relative costs of these agents are discussed.

Benzothiadiazines↗
PubMedDate not supplied

[Diuretics in the treatment of arterial hypertension].

BACKGROUND: Diuretic compounds, which comprise the basis of any cardiovascular prevention in subjects with hypertension, have never been studied in terms of clinical pharmacology according to the classical and well-established rules used nowadays with other anti-hypertensive agents. FINDINGS IN THE LITERATURE: Because edema was the first historical indication for diuretic compounds, very high doses were initially given for drug treatment of chronic hypertension. It was only 10-15 years ago that lower doses were first used due to the effectiveness of treatment in old subjects with hypertension and to the development of fixed associations with either converting enzyme inhibitors or beta-blocking agents. However, only a very small number of pathophysiological studies have been conducted in parallel, particularly to determine the effects on vessels and the endothelium. CONCLUSION: Diuretics are the most effective and the least expensive drugs for cardiovascular prevention of hypertension but the basic mechanisms of their action remains to be evaluated.

Antihypertensive Agents↗
PubMed1998

[Experimental studies on anti-inflammatory, antipyretic and diuretic effects of several species of tongcao and xiao-tongcao].

OBJECTIVE: To observe and compare the anti-inflammatory, antipyretic and diuretic effects of three kinds of Tongcao(Tongtuomu, Panyezhangyeshu and Luosan) and seven kinds of Xiao-tongcao(Ximashanjinjiehua, Xinanxiuqiu1. 2., Ditanghua, Suixuezhangcai, Qingjiaye and Zhongguo jinjiehua). METHOD: Decoctions prepared from the above kinds of Tongcao and Xiao-tongcao crude drugs were given to rats at dosages of 8 g/kg and 4 g/kg by ig. Pharmacological actions were observed by means of carrageenan-induced swelling paws, fever models induced by beer-yeast or carrageenan and metabolic cage method in rats. RESULT: All the experimental decoctions could inhibit carrageenan-induced swelling of rat paws in different degrees and exerted anti-pyretic effect on rat fever models induced by beer-yeast or carrageenan. Three kinds of Xiaotongcao(Ximashanjingjiehua, Xinanxiuqui2., Zhongguojinjiehua) had obvious diuretic effect on rats. CONCLUSION: Decoctions of different species of Tongcao and Xiao-tongcao all have anti-inflammatory, antipyretic and diuretic effects, thus providing some pharmacologic basis for the efficacy assay, clinical application, species collation and quality study of Tongcao and Xiao-tongcao.

Analgesics, Non-Narcotic↗
PubMedDate not supplied

Combined effect of captopril and thiazide diuretic on serum lipid profile in hypertensive women.

BACKGROUND: Hypertension has long been recognized as the major risk factor for the development of coronary disease. It was found that the combination of thiazide diuretic and ACE inhibitor has favorable antihypertensive and metabolic effect i.e. the combination reduces the levels of lipid. METHODS: 40 women aged between 35-60 years having systolic blood pressure equal to or greater then 160 mmHg were included in the study. Captopril in a dose of 25-75 mg plus thiazide 25-50 mg orally per day was given in divided doses. Before starting therapy and then after 4th and 10th week of therapy, 5 ml of fasting blood was drawn to analyze lipid profile like serum triglyceride, cholesterol and lipoprotein (HDL and LDL-Cholesterol). RESULTS: Study observed a marked decrease of blood pressure after taking captopril with diuretics. Level of triglyceride and of HDL and LDL-cholesterol were also significantly changed (P < 0.01) as compared to their controls. CONCLUSION: It was observed that captopril in combination of thiazide diuretics not only decrease blood pressure but also a beneficial effect on lipid profile. Hence further research is needed on large number of patients of both sexes.

Adult↗