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PubMed1979

Duration of effect of different diuretics.

Twenty-four patients with hypertension were treated with chlorothiazide, chlorthalidone, and frusemide. Each diuretic had a significant and similar antihypertensive effect. After cessation of the administration of diuretics, the antihypertensive effect persisted for a longer time with chlorthalidone than with the other two drugs. The full antihypertensive effect of chlorthalidone and chlorothiazide was still present 24 hours after the administration of the drugs was ceased, and the full effect of chlorthalidone was present 72 hours after the administration of the drug was ceased. Side effects related to a rapid diuresis were more common with frusemide. The study indicated that chlorthalidone could be given at 48-hour or 72-hour intervals, and that other diuretics may be given once daily to exert their full antihypertensive action.

Aged↗
PubMed1999

[Clinical study of treating infantile acute nephritis with antipyretic and detoxication, cooling blood and diuretic principle].

OBJECTIVE: To find out the relationship between nitric oxide and onset of infantile acute nephritis, and the effect of traditional Chinese medicine (TCM) and Western medicine (WM) combination therapy. METHODS: Dividing 44 infantile acute nephritis patients into two groups. Group 1 was treated with cooling blood and diuretic principle, together with WM, Group 2 was treated with antipyretic and detoxication, cooling blood and diuretic principle, together with WM. The content of nitrite/nitrate iron (Fe NO2/NO3) in blood before and after treatment were determined through Griess nitrate reduction method, then compared with that of 28 healthy children. RESULTS: The content of Fe NO2/NO3 being in acute nephritis period was obvious higher than that of control group and reconvalecent period, P < 0.01. The macroscopic hematuria was higher than that of microscopic hematuria, P < 0.01. Urinary alexin third element (C3) and alpha 2-macroglobulin (alpha 2-M) positive patients Fe NO2/NO3 was higher than that of negative ones, P < 0.01. Those complicated with infection Fe NO2/NO3 was higher than that without infection P < 0.01. Short term cure rate of group 2 was higher than that of group 1, P < 0.05. Nitric oxide may participate the onset and pathogenesis of infantile acute nephritis. CONCLUSION: TCM-WM combination therapy, especially antipyretic and detoxication, cooling blood and diuretic principle, could restrain nitric oxide from damaging tissue and remitting disease.

Acute Disease↗
PubMed1992

Effect of chronic treatment with diuretics on mouse liver: a morphological and microanalytical investigation.

In an attempt to produce an animal model for the disease cystic fibrosis (CF), mice were treated chronically with the diuretics amiloride and furosemide, in order to cause chronic inhibition of transepithelial ion transport. Experiments were carried out on adult mice (2 months treatment); in addition, pregnant mice were treated with diuretics, and tissue from offspring 2 and 7 days post partum was investigated. Since biliary cirrhosis is a common occurrence in CF, hepatocytes in the treated mice were investigated by X-ray microanalysis and by light and electron microscopy. Treatment with amiloride caused a significant decrease in cellular Na concentration in adult animals and in in utero treated mice 2 days after birth. The decrease in Na was paralleled by a decrease in Cl, but K levels were not affected. Furosemide caused a slight increase of cellular Na concentrations, especially in animals aged 7 days. In the adult animals, both amiloride and furosemide caused a significant decrease of the cellular Na and Cl levels. No signs of cirrhosis could be observed. Inconsistent changes in the accumulation of lipid droplets in hepatocytes of adult animals treated with amiloride were observed by electron microscopy. It can be concluded that chronic treatment with diuretics, even though it causes some, possibly pathological, changes of the liver, is only of very limited value for generating an animal model to study liver disease in CF.

Amiloride↗
PubMed1992

Diuretic induced hyponatraemia in the elderly.

Diuretics are an important cause of symptomatic hyponatraemia in the elderly. The hyponatraemia is often associated with hypokalaemia which may play a role in the aetiology. Diuretic induced hyponatraemia must be considered in the differential diagnosis of elderly patients presenting with altered sensorium or seizures. This is especially important in those known to be hypertensives since diuretics are frequently used to treat hypertension in the elderly.

Aged↗
PubMed2004

Stereochemistry of insect kinin tetrazole analogues and their diuretic activity in crickets.

Insect kinin analogues of the sequence Phe-Phe-psi[CN(4)]-Ala-Trp-Gly-NH(2) containing (L-Phe(2),L-Ala(3)) and (L-Phe(2),D-Ala(3)) stereochemical variants of the tetrazole moiety, a mimic of the type VI beta-turn, demonstrate significant agonist and partial antagonist activity, respectively, in a cricket diuretic bioassay. A comparison of the solution conformations of these two stereochemical variants indicates a structural basis for their divergent bioactivities. The (D-Phe(2),D-Ala(3)) stereochemical variant was synthesized and found to demonstrate significant agonist activity. The results further define stereochemical requirements for the diuretic activity of insect kinins in crickets and provide valuable information for the design of biostable analogues capable of disrupting digestive and diuretic processes in pest insects.

Amino Acid Sequence↗
PubMed1992

Diuretics, serum and intracellular electrolyte levels, and ventricular arrhythmias in hypertensive men.

OBJECTIVE: To investigate the patterns of electrolyte abnormalities resulting from thiazide administration and whether they cause ventricular arrhythmias, and to help resolve the controversy over whether clinicians should routinely prescribe potassium-conserving therapy to all patients treated with thiazides. DESIGN: Double-blind, randomized controlled trial. PARTICIPANTS: A total of 233 hypertensive men aged 35 to 70 years. INTERVENTIONS: Participants were withdrawn from prior diuretic treatment and were replenished with oral potassium chloride and magnesium oxide. They were then randomized to 2 months of treatment with (1) hydrochlorothiazide; (2) hydrochlorothiazide with oral potassium; (3) hydrochlorothiazide with oral potassium and magnesium; (4) hydrochlorothiazide and triamterene; (5) chlorthalidone; or (6) placebo. MAIN OUTCOME MEASURES: Ventricular arrhythmias on 24-hour Holter monitoring and serum and intracellular potassium and magnesium levels. RESULTS: Of the 233 participants, 212 (91%) completed the study. Serum potassium levels were 0.4 mmol/L lower in the hydrochlorothiazide group than in the placebo group (P less than 0.01), and this mean difference was not affected by supplementation with potassium, with potassium and magnesium, or with triamterene. However, the supplements did prevent the occasional occurrence of marked hypokalemia; all 12 of the men who developed serum potassium levels of 3.0 mmol/L or less were among the 90 who received diuretics without supplementation (P less than 0.01). Similarly, the overall proportion of men with ventricular arrhythmias was not affected by randomized treatment, but there was a twofold increase in the proportion with arrhythmias among the 12 men with serum potassium levels of 3.0 mmol/L or less (P = .02). Serum magnesium and intracellular potassium and magnesium levels were not reduced by hydrochlorothiazide, nor were they related to ventricular arrhythmias. CONCLUSIONS: In the majority of hypertensive patients, treatment with 50 mg/d of hydrochlorothiazide does not cause marked hypokalemia or ventricular arrhythmias. However, because some individuals will develop hypokalemia after starting diuretic therapy, serum potassium levels should be monitored and potassium-sparing strategies should be used when indicated.

Adult↗
PubMed1990

[Combination of a carbon dioxide bath and a diuretic--follow-up study of several days].

A series of 22 men underwent a 30 minute carbon dioxide bath and was simultaneously administered Hydrochlorothiazide SPOFA. Their renal response was studied, and that both separately to the bath or the diuretic and to their combination. Diuresis was increased by 200 l x 10(-3) after the carbon dioxide bath and by 500 l x 10(-3) after hydrochlorothiazide. This increase was even further enhanced after the combination of the two treatments. Sodium excretion showed a similar increase, whereas kaliuresis did not exhibit such a marked rise and the differences between the response to the bath and to the diuretic were small. Repeated combination of the carbon dioxide bath and the diuretic resulted in a slightly increasing diuresis over the days studied. The authors emphasize the necessity to understand the bath--drug interactions particularly in balneological practice and substantiate the advantage and usefulness of the combination studied in indicated cases.

Adult↗
PubMed1979

[The effect of diuretic therapy on serum lipoproteins: an undesirable effect?].

The effect of diuretics on serum lipids and lipoproteins was evaluated in 23 patients with essential hypertension treated with chlorthalidone for six weeks. Compared to placebo conditions, diuretic therapy significantly increased serum beta (+8%, p less than 0.05) or low-density-lipoprotein (LP) cholesterol (+17%, p less than 0.025). Since alpha-LP or high-density-LP cholesterol was unchanged or tended to decrease slightly, there was also an increase in the beta/alpha-LP (+26%, p less than 0.025) or low/high-density-LP cholesterol (21%, p less than 0.025) ratio. Serum cholesterol (+4%), triglycerides (+3%), phospholipids and the Apo-LP A-I, A-II and B were not changed significantly. Blood pressure and plasma potassium were decreased (p less than 0.01), blood volume and serum insulin were not changed significantly, and serum glucose was increased mildly. Plasma renin, aldosterone and norepinephrine levels rose significantly (p less than 0.05), while circulating epinephrine was unaltered. Alterations in LP were not related to variations in blood pressure, blood volume, plasma electrolytes or serum glucose or insulin; and they did not correlate with chlorthalidone-induced increases in plasma renin, aldosterone or norepinephrine. Treatment with certain diuretics may have an adverse influence on lipoprotein metabolism.

Adolescent↗
PubMed1989

Diuretic effect of bremazocine, a kappa-opioid with central and peripheral sites of action.

Intracerebroventricular or i.p. injections of bremazocine produced a dose-dependent diuretic response and increased glomerular filtration rate in hydrated as well as in nonhydrated rats. The potency and magnitude of the bremazocine-induced diuresis were more pronounced in the nonhydrated group of rats. That bremazocine has a central component of action is deduced from the fact that 0.1 microgram of the opioid administered centrally caused a significant increase in urine output; proportionally, larger doses of bremazocine were required to produce the same diuretic effect when the drug was administered parenterally. Bremazocine did not change the total amount of urinary Na+ and K+ as compared to the saline controls; it increased significantly the free water clearance. The bremazocine-induced diuresis was antagonized in a competitive fashion by 10 mg/kg of naloxone giving further support to the notion that the mechanism of action of bremazocine involves activation of kappa-opioid receptors. Bremazocine injected i.v. to nonanesthetized rats increased mean systemic blood pressure in a dose-dependent manner; the pressor action of the opiate was blocked and prevented by 1 mg/kg of naloxone. In contrast, i.c.v. administration of bremazocine did not change mean systemic blood pressure but produced a dose-related increase in urine output. To determine whether in addition to a central site bremazocine also activates a renal mechanism, experiments were performed in the isolated perfused rat kidney. Bremazocine (0.15-2.5 microM) caused a dose-dependent diuretic response and a significant rise in perfusion pressure as well as in glomerular filtration rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

A multicenter trial of low dose captopril administered twice daily in patients with essential hypertension unresponsive to beta blocker-diuretic treatment.

Two hundred and one patients with essential hypertension, whose supine diastolic blood pressure (SDBP) was greater than or equal to 95 mmHg following 2 weeks of treatment with the optimal dose of a beta blocker-diuretic combination (Phase 1), were randomly assigned to the addition of either 25 or 50 mg captopril BID for 6 weeks (Phase 2). At the end of Phase 2, the dose of captopril was doubled in the patients not normalized (SDBP greater than or equal to 95 mmHg) and maintained in the others (SDBP less than 95) for an additional 4 weeks (Phase 3). At the end of Phase 3, the beta blocker was withdrawn in the normalized (SDBP less than 95 mmHg) patients, and captopril plus diuretic was given for 4 weeks (Phase 4). The addition of captopril at either dose level led to a significant fall (p less than 0.01) in standing and supine diastolic and systolic blood pressure after the first 2 weeks of treatment. There was no significant difference in response between the two dose levels of captopril. At the end of Phase 2, 59.4% and 55.8% of patients, respectively, assigned to 25 and 50 mg captopril BID, were normalized. Doubling the dose of captopril (Phase 3) led to approximately an additional 30% of patients being normalized. At the end of Phase 4 (captopril plus diuretic) the SDBP was still less than 95 mmHg in 63% of patients, whereas it was increased in the others. Side effects were noted in 10 patients (5%). The incidence was similar in each treatment group, and a total of four patients (2%) were withdrawn due to side effects.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

[The quality of urography with iopamidol and various diuretic agents].

The results obtained in four successive trials based on the analysis of urography performed on patients with normal kidney function are reported. The scores obtained with a non-ionic contrast (iopamidol) were compared with those produced after injecting the same contrast medium with the addition of various diuretics (furosemide, various quantities of 5% glucose solution, 20% mannitol). The results obtained by injecting the diuretic together with the iopamidol were usually unsatisfactory. Injection of diuretic 15 ms after the iopamidol gave better results in the lower urinary tract, particularly the bladder. The best results were obtained by injecting 250 ml, 20% mannitol, after 15 ms. However this technique is not applicable to patients requiring a voiding cystourethrogram due to the inadequate opacification of the urethra it provides.

Adult↗
PubMed1988

Prescription diuretic abuse in patients with bulimia nervosa.

Bulimia nervosa, a common eating disorder usually characterized by binge eating and self-induced vomiting, may also involve abuse of prescription diuretics. This article describes four patients who abused prescription diuretics in large quantities (up to 2 g/d of furosemide) for extended periods of time. Physical examination and laboratory values provided few clues to the diagnosis of bulimia nervosa. Other eating-related behaviors previously linked to bulimia nervosa--including abuse of diet pills, illicit amphetamines, and laxatives, as well as withholding of insulin in one diabetic patient--were present in these cases. Usually the patients' primary physicians were not aware of these problems. Physicians should be aware that patients requesting prescription diuretics may have bulimia nervosa.

Adult↗
PubMedDate not supplied

A change of urinary proteins from a glomerular pattern to a tubular pattern during a late diuretic phase of acute renal failure.

The proteinuria on admission, on the 3rd day of the disease, of a 15-year-old male patient with acute renal failure (vasomotor nephropathy) showed a glomerular proteinuria-predominant pattern, and had a normal activity of N-acetyl-beta-D-glucosaminidase, indicating little proximal tubular damage. During a late diuretic phase, the excretion of N-acetyl-beta-D-glucosaminidase in the urine increased in accordance with increases of sodium excretion and urine flow, and then decreased to the normal range on the 20th day of the disease. Urine during the late diuretic phase showed a tubular proteinuria pattern and finally returned to a normal pattern on the 47th day of the disease. Thus, transient proximal tubular damage was evidenced in the late diuretic phase of the patient.

Acetylglucosaminidase↗
PubMed1986

Efficacy of low dose captopril once daily in diuretic resistant hypertension.

In 12 essential hypertensive patients insufficiently controlled by treatment with 50 mg hydrochlorothiazide, the blood pressure lowering effect of the addition of 25 mg captopril once daily was examined. Twenty four hour ambulatory blood pressure monitoring was performed using portable automatic recording devices before treatment, after 4 weeks of treatment with hydrochlorothiazide alone, and again after 4 weeks of combined treatment with captopril. The combined treatment yielded a marked additional blood pressure reduction in comparison with the previous medication of the diuretic alone. The additional antihypertensive effect of captopril lasted 24 hours. During the daytime between 08.00 h and 20.00 h the mean blood pressure was 158 +/- 13/100 +/- 8 mmHg before treatment. After treatment with hydrochlorothiazide alone it was 151 +/- 11/93 +/- 8 mmHg and after hydrochlorothiazide and captopril it was 140 +/- 13/88 +/- 9 mmHg. Our results indicate that the addition of only 25 mg captopril once a day to a diuretic may result in a marked additional blood pressure reduction or normalization in cases of insufficient control by the diuretic alone.

Adult↗
PubMed1986

Diuretic-induced hypokalemia and altered renal function.

The effect of a maximal dose of a commonly used diuretic, chlorthalidone, on renal function was assessed in 6 patients with untreated essential hypertension. 100 mg daily of chlorthalidone for a 4-week period produced a significant fall in the plasma potassium concentration and total body potassium content by 16 and 4.2%, respectively. Associated with this change in body potassium status was a 10% decrease in the maximum urine concentrating capacity (p less than 0.01). Renal plasma flow, but not glomerular filtration rate, was also depressed (9.2%) by diuretic therapy. These results suggest that small diuretic induced deficits in the plasma potassium concentration as well as the total body potassium status interfere with renal tubular function.

Aged↗
PubMed1965

[Idiopathic hypoparathyroidsm: provocation of a tetanic seizure by the injection of a mercurial diuretic].

Idiopathic hypoparathyroidism was diagnosed in a 55-year-old patient following rather unusual circumstances: he informed the emergency ward physician attending him for congestive cardiac insufficiency consequent to coronary cardiopathy that on the two preceding occasions when such insufficiency had been relieved by the injection of a diuretic, a tetanic seizure had ensued which was corrected by intravenous administration of calcium. Treatment of the cardiac insufficiency was nonetheless instituted with the mercurial diuretic: tetany appeared a few hours later, subsiding after intravenous injection of calcium. The various possible ways in which a tetanic seizure may be triggered by a mercurial diuretic are discussed.

Calcium↗
PubMed1984

Acute antihypertensive synergism of angiotensin-converting enzyme inhibitors and diuretics.

In spontaneously hypertensive rats (SHR), after 1 day of dosing with an angiotensin-converting enzyme (ACE) inhibitor (captopril or enalapril) plus a diuretic (hydrochlorothiazide), a synergistic antihypertensive effect was observed when a second dose of the combination or ACE inhibitor alone but not the diuretic alone was given the next day. Bilateral ureteral ligation did not prevent the synergism, which indicates that diuresis per se was not the mechanism. Vascular responses to various agonists did not differ in SHR given ACE inhibitor or ACE inhibitor plus diuretic. SHR given combination treatment had higher and more prolonged increases in plasma renin activity. Aprotinin or indomethacin did not alter the synergism, which suggests that endogenous kinins and prostaglandins did not play a role. These data suggest that the mechanism for the synergistic antihypertensive effect resulted from the combination treatment's shifting the blood pressure regulation system to be renin dependent and responding more to drugs affecting the renin-angiotensin system (RAS). Evidence was presented that the RAS can be shifted rapidly to assume a greater role in blood pressure regulation in SHR as well as in normotensive and two-kidney, one-clip Goldblatt renal hypertensive dogs by restricting sodium intake. The data may partly explain the various degrees of antihypertensive responsiveness of essential hypertensive patients to ACE inhibitors.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1984

Nonarrhythmogenicity of diuretic-induced hypokalemia. Its evidence in patients with uncomplicated hypertension.

Twenty patients aged 33 to 69 years with uncomplicated hypertension, no heart disease, and normal stress test results underwent ambulatory ECG monitoring a month after receiving placebo and two and four weeks after hydrochlorothiazide therapy. Serum potassium level (+/- SEM) averaged 4.4 +/- 0.09 mEq/L after the placebo trial and 3.4 +/- 0.07 and 3.0 +/- 0.06 mEq/L after two and four weeks of therapy, respectively. Sixteen patients had no arrhythmias. Four patients had 329 +/- 140 premature ventricular beats (PVBs) while receiving placebo and 341 +/- 203 and 315 +/- 158 PVBs per 24 hours after two and four weeks of therapy, respectively. Thus, patients with uncomplicated hypertension and no arrhythmias before diuretic therapy did not experience arrhythmias as a result of diuretic-induced hypokalemia of one month's duration. Patients with low-grade ventricular ectopy (VE) before therapy did not progress to higher grades of VE after diuretic treatment for four weeks.

Adult↗