High Blood Pressure Treatment (cont.)
John P. Cunha, DO, FACOEP
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Jay W. Marks, MD
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
In this Article
- What is high blood pressure (hypertension)?
- Which lifestyle modifications are beneficial in treating high blood pressure?
- Alcohol
- Smoking
- Coffee and caffeinated beverages
- Salt
- Other dietary considerations
- Obesity
- Exercise and stress reduction
- How is high blood pressure treated?
- Starting treatment for high blood pressure
- Treatment with combinations of drugs for high blood pressure
- Emergency treatment for high blood pressure
- Treatment during pregnancy
- Which medications are used to treat high blood pressure
- Angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers
- Beta blockers
- Diuretics
- Calcium channel blockers (CCBs)
- Alpha blockers
- Clonidine
- Minoxidil
- Renin inhibitors
- Aldosterone blockers
- Combining agents
- What about the patient's compliance with medication regimens?
- Is alternative medicine used to treat high blood pressure?
- What are the complications of high blood pressure?
- Can high blood pressure be prevented?
- What's new in high blood pressure?
- Find a local Internist in your town
Diuretics
Diuretics are among the oldest known medications for treating hypertension. They work in the tiny tubes (tubules) of the kidneys to promote the removal of salt from the body. Water also may be removed along with the salt. Diuretics may be used as single drug treatment (monotherapy) for hypertension. More frequently low doses of diuretics are used in combination with other antihypertensive medications to enhance the effect of the other medications.
The diuretic hydrochlorothiazide (HydroDIURIL) works in the far end (distal) part of the kidney tubules to increase the amount of salt that is removed from the body in the urine. In a low dose of 12.5 to 25 mg per day, this diuretic may improve the blood pressure-lowering effects of other antihypertensive drugs, and the low doses also can prevent the fluid retention (edema) associated with ACE and ARB drugs. The idea is to treat the hypertension without causing adverse effects sometimes seen with higher doses of hydrochlorothiazide. These side effects include potassium depletion and elevated levels of triglyceride (fat), uric acid, and glucose (sugar) in the blood.
Occasionally, when salt retention causing accumulation of water and swelling (edema) is a major problem, the more potent 'loop' diuretics may be used in combination with other antihypertensive medications. The loop diuretics are so called because they work in the loop segment of the kidney tubules to eliminate salt.
The most commonly used diuretics to treat hypertension include hydrochlorothiazide (HydroDIURIL) and chlorthalidone, the loop diuretics furosemide (Lasix) and torsemide (Demadex), the combination of triamterene and hydrochlorothiazide (Dyazide), and metolazone (Zaroxolyn). For individuals who are allergic to sulfa drugs, ethacrynic acid, a loop diuretic, is a good option. Diuretics generally should not be used in pregnant women. (See the preceding section on pregnancy.)
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