How do diuretics work?
When hypertension occurs in the body of patients with sodium and fluid retention, in this regard, it is of great importance to take diuretics, which increase the release of fluid and sodium from the body. As a result, the volume of circulating blood and extracellular fluid decreases, which leads to a decrease in blood pressure.
What diuretics are there?
Doctors distinguish 3 types of diuretics: loop, thiazide and potassium-sparing.
Loop diuretics are characterized by high strength and short duration of action. They are usually used when hypertension is combined with heart or kidney failure, as well as in emergency situations (pulmonary edema, hypertensive crisis, brain edema). To loop diureticum include furosemide, bumetanide, ethacrynic acid.
Thiazide diuretics are used for long-term treatment of hypertension. They are inferior to loop diuretics in strength, but give a longer diuretic effect. The main representative of thiazide diuretics is hydrochlorothiazide. Recently, thiazide-like diuretics have become widely popular-this is indapamide and its prolonged (slow-release) form. Thiazide diuretics are currently used in small doses and, as a rule, as part of combined drugs.
Potassium-sparing diuretics, unlike diuretics of the other two types, do not increase the excretion of potassium (as their name implies), but on the contrary, cause its delay in the body. These include spironolactone, amiloride, triamterene.
When taking large doses of loop and thiazide diuretics in some patients, the level of potassium in the blood decreases (hypokalemia), which can cause heart rhythm disorders. The addition of potassium-sparing diuretics can prevent the development of this side effect.
In what cases does the doctor prescribe diuretics?
Diuretics are prescribed primarily to elderly patients with so-called isolated systolic arterial hypertension (systolic blood PRESSURE is increased, and diastolic blood PRESSURE is normal) and heart failure. However, the use of diuretics is not limited to this.
For the treatment of hypertension, a combination of two or more drugs is often used. Diuretics are often the second drug combined treatment of hypertension.
When can I not prescribe diuretics?
Loop and thiazide diuretics are contraindicated in reducing the level of potassium in the blood (hypokalemia), so before their appointment, it is desirable to examine the level of potassium in the blood. It is not recommended to use them for cirrhosis of the liver, gout, diabetes, a significant increase in cholesterol in the blood. These drugs are not prescribed during pregnancy and breast-feeding. Thiazide diuretics, unlike loop diuretics, are not recommended for chronic renal failure.
Indapamide has certain advantages over other thiazide diuretics, which does not significantly affect the metabolism of fats, carbohydrates and uric acid. This allows you to prescribe it to patients with diabetes, gout, high cholesterol in the blood.
Potassium-sparing diuretics are not used for increased potassium content in the blood, renal failure. Their combined use with ACE inhibitors, potassium preparations is undesirable.
Be sure to tell your doctor:
- Do you suffer from cirrhosis of the liver, gout, diabetes.
- Have you ever had elevated levels of uric acid, blood sugar, kidney or liver changes?
- Whether you have taken diuretics before, how You reacted to them.
What is good about thiazide diuretics?
Thiazide diuretics are very effective tools for the treatment of hypertension, both in the form of monotherapy and in combination with other drugs. They reduce blood pressure well, and when taken in small doses, and are usually well tolerated (side effects are rare). It is known that thiazide diuretics reduce the risk of cardiovascular accidents (stroke, myocardial infarction).
The relatively low cost of diuretic treatment is also important.
Why do we need potassium-sparing diuretics?
Potassium-sparing diuretics are practically not used as monotherapy for hypertension. Their main purpose-prevention of hypokalemia (ie, reducing the content of potassium in the body), which occurs when using thiazide diuretics. In addition, drugs of this group are prescribed to enhance the action of other diuretics.
Potassium-sparing diuretics are widely used in the treatment of hypertension in combination with heart failure. They eliminate the influence of aldosterone (adrenal hormone), which causes sodium and fluid retention in the body and increase blood PRESSURE.
How should I take diuretics? Please note!
Diuretics are taken orally once in the morning or twice in the morning before meals.
Do not take diuretics in the second half of the day, because in this case, the maximum diuretic effect will have at night, and prevent sleep.
Sometimes it is enough to take diuretics only 2-3 times a week.
During treatment with diuretics, it is necessary to monitor the amount of liquid consumed and excreted (especially at the beginning of treatment). If too much urine is released (2-3 times more than the volume of liquid drunk), as well as there is weakness, rapid heartbeat, and significantly decreases blood pressure, you should consult a doctor.
Diuretics increase the excretion of urine, i.e. water and electrolytes (sodium and potassium). Excretion of liquid and sodium from the body helps to reduce blood pressure. However, the excretion of potassium can lead to depletion of its reserves in the body and the development of a number of side effects. In this regard, during treatment with loop and thiazide diuretics, it is necessary to include in the diet foods rich in potassium (potatoes, dried apricots, bananas, persimmons). Sometimes the doctor prescribes potassium-sparing diuretics together with thiazide diuretics. In any case, do not neglect their reception. It is necessary to regularly check the content of potassium in the blood serum.
What adverse (side) effects are possible when taking diuretics?
The main side effects of diuretics are associated with a violation of potassium metabolism. When taking loop and thiazide diuretics, a decrease in the level of potassium in the blood (hypokalemia) may develop, while using potassium – sparing diuretics-an increase in the level of potassium in the blood (hyperkalemia).