What Are the Pros and Cons of Diuretics for Hypertension?

Diuretics are an important component of treatment strategies for patients with fluid retention heart failure (heart failure). Comparative trials with furosemide alone or captopril alone found that fluid retention was more common in patients with heart failure treated with captopril than with diuretics. The patients included in the multi-center trial were all with symptoms and fluid retention under complete control. Patients with heart failure who could not maintain clinical stability for a long time were treated with a single diuretic, and a combination of diuretics and angiotensin converting enzyme inhibitor (ACEI) Reduced chance of clinical decompensation. Therefore, diuretics are indispensable drugs for the treatment of heart failure.

Diuretics

Diuretics are fluid retention heart failure (

Diuretics are divided into several types, different diuretics have diuretic principles or different parts, and the side effects are similar. Diuretics can cause decreased blood pressure and dehydration. Most diuretics cause hypokalemia, with the exception of potassium-preserving diuretics. Patients are encouraged to eat potassium-rich foods during hypokalemia. Pay attention to the situation of blood potassium when using diuretics, because hypokalemia can easily cause digitalis drug poisoning. Diuretics are generally recommended to be taken in the morning, not before going to bed at night to avoid affecting sleep. Pay attention to urine output after using diuretics.

Thiazide: for example

Diuretic hypotension began in 1948, but due to the toxicity and necessity of mercury diuretics

According to the results of large-scale international clinical trials, the antihypertensive effect of diuretics has been confirmed. In combination therapy, when other antihypertensive monotherapy is not effective, adding diuretics has a significant effect. Diuretics are especially effective for the elderly and obese hypertensive patients.

1. Monotherapy: According to the general recommended dose, the antihypertensive amplitude of various antihypertensive drugs is generally similar. The typical situation is with

1. Thiazine diuretics are used to treat hypertension, especially suitable for patients with mild to moderate hypertension, elderly patients with simple systolic hypertension, obesity and hypertension with heart failure.

2. Decide whether to use hydrochlorothiazide according to the presence or absence of disease, have impaired glucose tolerance or

1. "Cardiotoxicity" of diuretics. In 1987, the famous American heart expert Kaplan and others believed that hydrochlorothiazide could not be reduced.

Reduces circulating blood volume through its diuretic and natriuretic effects, and reduces vascular tone by reducing the amount of sodium ions in the vessel wall. Diuretics are widely used in the treatment of heart failure and hypertension, and play a pivotal role in the treatment of these diseases. Thanks to this category

(1) Renal blood flow is reduced. The effect of diuretics depends on sufficient renal blood flow. Only by maintaining important renal blood flow can diuretics fully exert their diuretic effect;

(2) Electrolyte disorders. During the diuretic process, especially when a large amount of continuous medication is used, electrolyte disorders often occur, leading to a diminished diuretic effect;

(3) secondary aldosterone increase. After a large amount of diuresis in patients with liver cirrhosis, the secondary circulation may increase due to a decrease in effective circulation capacity. Wells often have metabolic alkalosis;

(4) Influence of colloid osmotic pressure. Edema or ascites is often accompanied by low plasma protein, which is the main factor to maintain blood volume. When the plasma colloid osmotic pressure is reduced, the interstitial fluid does not easily enter the blood vessels, and if not corrected, it may lead to a decrease in the effect of diuretics;

(5) Physical weakness. Physical weakness, often secondary to delayed adrenal function, so poor response to diuretics, give a small dose of prednisone or dexamethasone, and then apply diuretics after 3 to 5 days, can get a good response;

(6) Other. Rest or avoid salt is also an important part to ensure the effectiveness of diuretics. Of course, the treatment of the etiology cannot be ignored. In addition, attention should be paid to the situation of hyponatremia, etc. The diuretic effect can only be obvious after correcting the cause of undesired hyponatremia. ^[1]