Diuretics for BP–Tried and True

 

Looking at the scale, Vic thought, “What could I possibly have eaten that would cause me to gain four pounds in one day?” On taking inventory, he found that he could not possibly have eaten enough extra calories (14,000) to gain that much weight in such a short period. He had, however, consumed more than his share of sodium–a corned beef sandwich with potato chips and two large dill pickles. That meal undoubtedly contributed to the extra four pounds of water weight he was carrying. A few months later, Vic was diagnosed with high blood pressure, put on a diuretic medication and advised to limit his sodium intake.

An estimated 65 million Americans have high blood pressure, although nearly a third of them don’t know it. One major cause, as in Vic’s case, is salt sensitivity that causes the body to retain fluids, increasing blood volume and making the heart work harder. Salt is everywhere–in restaurant meals, prepared and canned foods–and most Americans consume three or four times more salt than they need. When blood pressure is elevated, doctors usually recommend limiting sodium intake to no more than 1,500 milligrams per day. In addition to that and other lifestyle measures, diuretic medication is recommended as first line treatment by the Joint National Commission on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VI). Also known as water pills, diuretics work by causing the kidneys to flush excess sodium and water from the body which in turn helps relax blood vessel walls.

Outperforms Other Drugs
Although there are many newer and more expensive blood pressure medications available, the guidelines are based in part on the large ALLHAT study (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) published in 2002 in the Journal of the American Medical Association.
Among more than 33,000 ALLHAT subjects treated for an average of five years, those taking diuretics were less likely to suffer a stroke, develop congestive heart failure or be hospitalized for heart problems compared to subjects taking calcium channel blockers or ACE inhibitors. They had about the same rate of suffering heart attacks or dying from heart disease. More than 17 other large long-term studies have confirmed the effectiveness of diuretics.
The good news is that diuretics are not only considerably less expensive than other hypertension drugs (costing pennies a day rather than dollars) but have a long-term safety record established over 40 years of use.
At the time of the study, diuretics had been declining in popularity, dropping from 52 percent of all hypertension prescriptions in 1982 to 27 percent in 1992.
Most commonly prescribed for early hypertension are thiazide diuretics. Chlorthalidone was used in ALLHAT, but a more common choice today is hydrochlorothiazide (HCTZ), which has fewer side effects.
Thiazide diuretics can cause the body to flush out potassium as well as sodium, and potassium is needed for muscles and to keep the heart working properly. As a result, thiazide diuretics are often prescribed along with a potassium supplement or with a potassium-sparing diuretic such as triamterene. Vic’s pill was a combination of hydrochlorothiazide and triamterene.
Loop diuretics are more powerful and often prescribed for congestive heart failure, liver disease or emergency situations involving fluid retention. Loop diuretics include furosemide and bumetanide.
The major side effect of diuretics–and the only one Vic experienced regularly–is frequent urination which usually continues for about four hours after the medication is taken each day. To avoid sleep interruption, it’s recommended that the pill be taken just after breakfast and no later than 4 p.m.
Other possible but not very common side effects include lightheadedness when getting up quickly from a sitting or standing position; tiredness, weakness or muscle cramps; dehydration (including dizziness, extreme thirst and dry mouth) and skin rash. Some diuretics can also make your skin more sensitive to the effects of sunlight.
Most men are aware of the potential for erectile dysfunction with diuretics. This effect is probably not as common as believed. Erection problems are associated with hypertension itself, and Vic had difficulty before he started taking medication. Whatever the cause, his ED responded readily to treatment with Viagra.
Diuretics can also raise cholesterol and increase the risk of gout and diabetes–but ordinarily only at doses higher than those recommended today.
Vic’s doctor asked him to check his blood pressure regularly with a home monitor. And the doctor ordered blood tests every six months to monitor any effect the treatment was having on his kidneys and liver Many patients, particularly those with high readings or blood pressure that’s resistant to treatment, may need another medication, along with a diuretic.
By flushing out excess fluids, diuretics reduce blood volume, but they have an effect on blood pressure that apparently is independent of this effect and that occurs at a lower dos

Other Uses for Diuretics Hypertension is not always associated with fluid retention. And conversely fluid retention can occur without high blood pressure or any other medical problem. Some individuals get puffy ankles and feet after prolonged sitting or standing. And women often have fluid retention related to hormone changes immediately before their menstrual periods. The solution in such cases is drinking more water, eating less salt and being more physically active. Some foods such as cranberry juice, coffee, watermelon and apple cider vinegar are natural diuretics.

Edema, or swelling caused by accumulation of fluid in body cells, is associated with a number of serious illnesses such as congestive heart failure, enlarged left chamber of the heart, kidney disease, cirrhosis of the liver and thyroid problemsThese illnesses usually require more powerful diuretics and in higher doses. Congestive heart failure and kidney disease can occur as late effects of uncontrolled hypertension. When the late President Franklin D. Roosevelt was diagnosed with hypertension, in the days before good treatments were available, he progressed within a decade to severe cardiovascular problems that led to his death. Vic has kept his blood pressure under tight control for 14 years through exercise, diet and one water pill a day.