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At least 1,279 records · Page 71Linked to original sources
PubMed1988

[Long-term diuretic treatment in nursing home residents. Is discontinuation possible?].

In this study the need for long-term diuretic therapy was investigated in nursing home patients. In 24 patients the need for diuretics was reassessed and the therapy was discontinued if possible. In 17 of the 24 patients therapy was discontinued. There was a follow-up of 17 days. Four patients developed congestive heart failure, and one patient died during the observation period after a series of complicating events. In the remaining 12 patients therapy had been discontinued successfully. Their mean body weight rose with 0.5 kg, and there were no significant changes in physical examination, serum creatinine, urea, potassium and hematocrit. It was concluded that it was possible in a substantial part of the population studied to discontinue diuretics, when there was no obvious current indication for this treatment. Careful clinical observation is needed to guarantee early detection of (recidive of) congestive heart-failure or hypertension.

Aged↗
PubMed1987

Lack of effect of piretanide (a potassium-stable diuretic) on serum magnesium.

Serum magnesium and potassium concentrations were determined in 188 patients undergoing diuretic treatment for mild to moderate hypertension in four controlled clinical trials (eleven treatment groups). Measurements were made before and after 12 weeks of treatment with piretanide monosubstance (including the retarded form) in the range 3 to 12 mg daily, with triamterene as monosubstance and in fixed dose combination with piretanide, and with amiloride in combination with hydrochlorothiazide. Eumagnesaemia and eupotassaemia were preserved at all dosage of the piretanide monosubstance. Mean serum potassium concentrations were significantly increased following treatment with the potassium-sparing agents triamterene (with and without piretanide) and amiloride in combination with hydrochlorothiazide. These changes were not accompanied by changes in mean serum magnesium levels, that is, a magnesium-sparing effect was not demonstrated. Individual values of changes in serum magnesium levels before and after diuretic therapy did not correlate with the corresponding changes in serum potassium levels in any of the eleven groups of patients. This result is in contrast to the findings of other authors, which suggested that serum magnesium and potassium levels were correlated. Long-term treatment with diuretics can lead to hypomagnesaemia and hypokalaemia, and, if in combination with a potassium-sparer, to hyperkalaemia. The results of this analysis show that piretanide, in addition to its smooth and effective antihypertensive action, is also able to preserve serum magnesium and potassium homeostasis when administered in the range of 3 to 12 mg for 12 weeks.

Amiloride↗
PubMed1986

Minoxidil, nadolol, and a diuretic. Once-a-day therapy for resistant hypertension.

We tested a once-a-day antihypertensive regimen using minoxidil, nadolol, and a diuretic in 55 patients with resistant hypertension. Forty-seven patients had evidence of end-organ damage. Twelve had mild renal insufficiency (serum creatinine concentration, 2.5 +/- 0.3 mg/dL). In 34 patients, treatment with nadolol and a diuretic was started with minoxidil added one to four weeks later. In the remainder, minoxidil, nadolol, and a diuretic were begun simultaneously because of severe hypertension. Initial supine and standing blood pressure (BP) in the 55 patients were 186 +/- 4/111 +/- 2 and 180 +/- 4/108 +/- 2 mm Hg, respectively. After 7 +/- 1 weeks, BP was controlled in 46 patients (84%) with the supine and standing BP reduced to 140 +/- 3/80 +/- 1 and 134 +/- 3/80 +/- 1, respectively. In six patients, BP was controlled but intolerable side effects occurred, making the regimen therapeutically successful in 40 patients (73%). The BP remained controlled during a follow-up of 43 +/- 5 weeks. In 31 patients, BPs measured 24 hours after the last dose were not different from random measurements. Mean serum creatinine levels remained stable in the 12 patients with renal insufficiency.

Adult↗
PubMed1979

Effect of diuretics on ADP incorporation in kidney mitochondria.

The effect of diuretics on incorporation of ADP in mitochondria isolated from rabbit renal cortex and medulla was examined. Inhibition of incorporation of [14 C]ADP into both types of mitochondria was observed following pretreatment with furosemide, ethacrynic acid and meralluride at high drug concentrations (7.5 x 10-4 M furosemide and ethacrynic acid, 6.4 x 10-3 M meralluride). At lower concentrations (7.5 x 10-5 M furosemide and ethacrynic acid, 6.4 x 10-4 M meralluride), only entry of ADP in medullary mitochondria was inhibited. Chlorothiazide, 1.7 x 10-3 M, did not inhibit incorporation of ADP into either mitochondrial preparation. Atractyloside, a classic inhibitor of ADP-ATP exchange, showed inhibition in both preparations. Furosemide, injected in vivo inhibited incorporation of ADP into medullary but not cortical mitochondria. These results are consistent with the possibility that loop diuretics may reduce tubular sodium reabsorption by inhibiting ADP-ATP exchange across the mitochondrial membrane, thereby depriving active transport processes of ATP. The differential action on cortical and medullary mitochondria by loop diuretics is consistent with their predominant site of action in the tubule and with the different morphologic characteristics of both types of mitochondria.

Adenosine Diphosphate↗
PubMed1965

Clinical trial of a new diuretic, furosemide: comparison with hydrochlorothiazide and mercaptomerin.

A clinical trial was carried out with the object of comparing the effects of furosemide, a new oral diuretic agent, with those of mercaptomerin and hydrochlorothiazide. Eleven edematous patients were chosen for the study and the diuretics were rotated, each drug being preceded by a one- to three-day control period. The patients served as their own controls. Urine electrolytes, body weight, and blood chemistry were monitored.Furosemide was shown to be an effective diuretic in this clinical study; under the conditions of the trial a single oral dose of 80 mg. of furosemide produced a natriuretic response in a 24-hour period equivalent to that achieved with a single oral dose of 100 mg. of hydrochlorothiazide or a single dose of 2.0 c.c. (80 mg. of mercury) of mercaptomerin given intramuscularly.

Adult↗
PubMed1982

On metabolic effects of diuretics and beta-blockers. Results from a cross-sectional and longitudinal population study of women.

A population sample of women in Göteborg, Sweden, was studied in 1968-69 and restudied in 1974-75. A number of metabolic variables could be studied cross-sectionally (in 1974-75) and longitudinally (intraindividual changes between 1968-69 and 1974-75). When studied cross-sectionally, increased serum urate concentrations were observed in women on diuretics and increased serum triglycerides in women on beta-blockers, compared to other women, while no obvious differences were found in blood glucose and serum cholesterol concentrations or in packed red cell volume (PCV). When studied longitudinally, a slight decrease in serum triglyceride concentration was found in women who started to take diuretics and an increase in women who started to beta-blockers compared to other women. Serum urate concentration tended to increase in women who started to take diuretics and PCV tended to decrease in women who started to take beta-blockers. Blood glucose was unimpaired. In conclusion, the differences observed were rather small and seemed to be rather unimportant compared to the threat presented by the arterial hypertension itself.

Adrenergic beta-Antagonists↗
PubMed1984

Coronary heart disease and the treatment of hypertension: impact of diuretics on serum lipids and glucose.

In summary, diuretic-based antihypertensive therapy causes glucose intolerance and raises glycohemoglobin concentrations as well as blood cholesterol and triglycerides. Various indices of glucose intolerance correlate with alterations in lipid concentrations. The correlations suggest that these metabolic disturbances are linked or have a common mechanism. When the three CHD risk factors of glucose, cholesterol and SBP are considered together, the net change during diuretic-based treatment may not be uniformly favorable. Other antihypertensive regimens might produce a move salubrious effect on the risk factors. Once identified, such regimens will need to be tested against diuretic regimens to ascertain whether the theoretical advantage suggested by risk factor analysis translates into a reduction in real-life coronary events.

Blood Glucose↗
PubMed1978

[Anti-ischemic action of diuretics].

Rat experiments were conducted for comparative study of the effect of diuretics, injected into the organism in a single dose prior to two-and-a-half-hour ischemia of an only kidney and after it, on the extent of the kidney affection and survival of the animals. It was established that furosemid, etacryn acid and mannitol exert a preventive protective effect in ischemia of the kidneys and considerably increase the survival of rats as compared to the control-group. Analysis of the renal function in the first five days of the postischemic period testifies to the property of the above-mentioned diuretics for normalizing excretory processes on the 2nd-4th days of the action of the injuring agent, and for relieving or shortening the oligoanuric phase of acute renal failure. The significance of metabolic shifts, intratubular hydrodynamics and vascular microcirculation in the mechanism of the protective effect of diuretics in ischemia of the kidneys is discussed.

Animals↗
PubMed1984

Diuretics 1984.

Diuretics increase water excretion by inhibiting sodium transport in the nephron. They can be grouped according to their chemical class or (more practically) their site of action in the nephron. The site determines certain features of their effect, an important one being their effect on potassium excretion. Diuretics which act late in the nephron inhibit sodium transport in the region in which potassium is secreted, causing retention of potassium and hydrogen ions. These diuretics produce a hyperkalaemic acidosis; most others cause loss of potassium and hydrogen and a hypokalaemic alkalosis.

Anesthetics↗
PubMed1983

[The effect of beta receptor blockers and diuretics on blood pressure reactivity].

Previous studies showed the importance of the response of blood pressure to emotional stress in essential hypertension. However, it is unclear to what extent the response of blood pressure to emotional stress is influenced by antihypertensive treatment, and especially by beta-blockers. In the present study the influence of antihypertensive treatment with either beta-blockers (beta) or diuretics (D) was compared in two series of experiments on male hypertensives, carried out after 2 weeks (beta, n = 11; D, n = 11) and 1 year of treatment (beta, n = 11; D, n = 9). One of the two drugs was randomly allocated to each patient. In the first series of experiments an ergometric exercise test was also performed (workload depending on age and body surface area, 60-100 W). The two medications caused a similar decrease in basal blood pressure. The response of blood pressure to emotional stress was also the same in both groups, and equal to that in untreated hypertensives. However, the reaction of systolic blood pressure to dynamic exercise was lower in the patients treated with beta-blockers (30.2 +/- 9.5 mm Hg) than in those treated with diuretics (42.9 +/- 12.1 mm Hg; p = 0.013). The effect of antihypertensive treatment on the reactivity of blood pressure therefore cannot comprehensively be tested by means of a single stress test. In terms of controlling the response of blood pressure to stress, beta-blockers are not generally more effective than diuretics, but only in certain situations.

Adult↗
PubMed1984

Benefits of low vs high dosages of diuretics.

The mechanism of antihypertensive action of diuretics is outlined, side effects of diuretic therapy are described briefly, and the advantages of lower dosages of diuretics (usually given concomitantly with a beta-blocker or a centrally acting alpha-agonist) are reviewed. Clinical guidelines include a recommendation that serum potassium levels be carefully monitored.

Blood Pressure↗
PubMed1981

[Metabolic effects of diuretics (author's transl)].

Thiazide diuretics and loop-diuretics, often used for treatment of hypertension, interfere with various metabolic reactions: An increase of uric acid in plasma is a regular finding, but gout will not be caused, an elevation of plasma lipoproteins has been observed but did not proceed to pathological values, in a number of patients blood glucose has been raised but without producing diabetes mellitus. In general, these metabolic interference are of minor pathological significance. Special treatment for these side-effects are needed in a few cases only. The indicated use of thiazide diuretics should not be disregarded because of their effects on regulatory mechanisms of metabolism.

Benzothiadiazines↗
PubMed1983

Review article. Magnesium deficiency provoked by diuretics.

Many diuretics cause hypermagnesiuria which may lead to magnesium deficiency, presenting as hypomagnesaemia, cardiac arrhythmias and tetany. Loop diuretics cause hypermagnesiuria mainly through direct blockade of magnesium reabsorption at the loop of Henle. Distal tubular diuretics block magnesium reabsorption at the distal convoluted tubule and also reduce magnesium reabsorption at the loop of Henle by an indirect mechanism.

Diuretics↗
PubMed1983

Diuretic effect and pharmacokinetics of tizolemide in subjects with normal and decreased renal function.

Tizolemide, a new sulphonamide diuretic, has alkaline properties and is cleared by a tubular transport system which differs from the PAH-excreting system which transports thiazide diuretics. The effect of this drug on the excretion of sodium and other electrolytes, and its pharmacokinetics, were evaluated in 5 healthy volunteers and in 10 patients with renal disease who had GFRs ranging from 5-98 ml/min. The saluretic effect of tizolemide was compared with that of placebo. The increase in sodium and chloride excretion after a single dose of 50 mg i.v. was clearly dependent on residual renal function but could be observed in all except one patient. It remains to be assessed whether a full diuretic effect can be achieved in patients with renal insufficiency if higher doses are used. The plasma half-life was 3.0 hours in healthy subjects but increased in patients with renal insufficiency to a maximum of 52 hours. In normal subjects total plasma clearance (611 ml/min) mainly depended on the renal clearance (564 ml/min) which decreased in proportion to GFR, whereas non-renal clearance remained unchanged. The large apparent volume of distribution of the drug (166 l/1.73 m2 BSA) did not increase significantly in uremia. Clinical trials with this drug in patients with reduced renal function must take into account the expected prolongation of its half-life.

Adult↗
PubMed1978

Pharmacological analysis of the action of diuretics in the newborn pig.

The effects of furosemide, ethacrynic acid, hydrochlorothiazide and amiloride on renal function of newborn piglets, 5 to 10 days old, were evaluated. Furosemide and ethacrynic acid were the most effective diuretics. Furosemide infusion at 0.5 mg/kg/hr inhibited reabsorption of 21% filtered sodium and ethacrynic acid, 1 mg/kg/hr, increased fractional sodium excretion to 29%. Hydrochlorothiazide infusion produced a milder natriuresis than furosemide or ethacrynic acid. Infusion of hydrochlorothiazide at 1.0 mg/kg/hr increased fractional sodium excretion from 0.3% during the control period to 7.2%. Furosemide, ethacrynic acid and hydrochlorothiazide each increased potassium excretion to near 20 microEq/min. amiloride (1.0 mg/kg/hr) increased fractional sodium excretion from 0.2% during control period to 2.8% during drug infusion but did not affect potassium excretion. When infused in combination with furosemide and hydrochlorothiazide, amiloride increased the natriuresis and decreased the kaliuresis of both diuretics. It is concluded that the unanesthetized piglet is a good model for renal function of immature mammals and responds to diuretics in a manner qualitatively similar to adults.

Animals↗
PubMed1982

[The effect of beta-receptor antagonists and diuretics and their combination on blood pressure and pressure-rate product during ergometric work in hypertensive patients (author's transl)].

1. Hypertensive patients are particularly endangered by disproportionately high increases in blood pressure during daily physical and emotional activity. For this reason, antihypertensive drugs should also be able to influence there pressure changes. 2. Therefore the ability of the beta-receptor antagonist acebutolol (400 mg/die) and of the diuretic mefrusid (25 mg/die) to reduce exercise-induced increases in blood pressure and pressure-rate product during and after standardized ergometric work (50--100 watts) was compared in a within-patient study of 42 outpatients with arterial hypertension (stage 1 to 2, WHO) aged 18 to 50 years. 3. Both drugs resulted in a significant reduction of systolic (p less than 0.05-p less than 0.001) and diastolic (p less than 0.05-p less than 0.001) blood pressure at rest. However, systolic and diastolic blood pressure (p less than 0.001) and pressure-rate product (p less than 0.001) during exercise were only significantly reduced by acebutolol. 4. The strongest blood pressure lowering effect under all conditions could be proven for the free and fixed combination of acebutolol and mefrusid. 5. From these findings it is concluded: (1) beta-adreno-receptor blocking agents are the drugs of first choice in the baseline therapy of mild to moderate arterial hypertension, (2) diuretic drugs potentiate the antihypertensive effect of beta-blocking agents. 6. This therapeutic regimen is recommended especially for hypertensives with ischemic heart disease, because diuretics fail to reduce pressure-rate product as a measure of myocardial O2-consumption.

Acebutolol↗
PubMed1982

Biochemical cardiac risk factors during diuretic therapy.

The effects of six weeks of treatment with fixed doses of the diuretics chlorthalidone and ticrynafen on serum total cholesterol, low density lipoproteins, high density lipoproteins, triglycerides and other biochemical parameters were studied in 24 hypertensive patients. Chlorthalidone increased total serum cholesterol by 40 +/- 11 (SEM) mg/dl (P less than 0.01) and triglycerides by 80 +/- 30 mg/dl (P less than 0.05). The increase of 16 +/- 12 mg/dl in low density lipoproteins and the decrease of 5 +/- 6 mg/dl in high density lipoproteins induced by this drug were not significant. An investigational uricosuric diuretic, ticrynafen, caused no significant changes in any of the serum lipid concentrations measured. Fasting blood glucose levels were elevated, but not significantly, by both diuretics. Serum uric acid concentrations tended to increase in patients given chlorthalidone while ticrynafen treatment decreased uric acid levels by 2.9 +/- 1.4 mg/dl (P less than 0.01). The elevations induced by chlorthalidone in serum lipid levels may partially counteract the potential benefits of its antihypertensive effects.

Adult↗
PubMed1982

[Continuous long-term treatment with diuretics of hypertension and the status of the renin-angiotensin-aldosterone system].

One hundred fifty eight patients with essential hypertension (both in- and out-patients) at stages IIA and IIB were treated with diuretics: furosemide (120 mg/day) during three days followed by hydrochlorothiazide in the doses that allow maintaining the renal sodium and water transport of the changed level. Criteria developed for prognosis of the efficiency of diuretic therapy according to the degree of reduction of the mean BP and plasma renin activity after 3-day furosemide intake; indications were worked out for a simultaneous prescription of the potassium-sparing drug amiloride. A good hypotensive effect was noted (reduction of the mean BP by 10 mm Hg) during the first month of treatment in 60 and 70% of in-patients, and in 22 and 40% out-patients with IIB and IIA stages of the disease, respectively. During 6 months of prolonged treatment with diuretics (1-2 years) the sensitivity of the patients to the therapy was increased that permitted the dose of hydrochlorothiazide to be reduced to 25 mg a day or every other day. Patients with good hypotensive effect of therapy were noted to have less pronounced degree of activation of the renin-angiotensin-aldosterone system, than that in patients with ineffective treatment.

Adult↗