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February 10, 2012

High Blood Pressure Treatment (cont.)

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Diuretics

Diuretics are among the oldest known medications for treating hypertension. They work in the tiny tubes (tubules) of the kidneys to remove 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 anti-hypertensive 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 anti-hypertensive 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 anti-hypertensive 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), 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 probably should not be used in pregnant women. (See the section above on pregnancy.)


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