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Home > Health Conditions > Hypertension > diuretics
Click here for why I feel
that Micardis® (telmisartan) should be the first
line treatment for hypertension.
Potassium Loss From Blood Pressure Drugs May Explain Higher Risk Of Adult
Diabetes - Science Daily, 11/24/08 - "a drop in
blood potassium levels caused by diuretics commonly prescribed for high
blood pressure could be the reason why people on those drugs are at risk for
developing type 2 diabetes" - See
potassium products at iHerb.
DASH Diet Acts Through Diuretic Effect To Lower Blood Pressure - Doctor's Guide, 5/20/03
- DASH Diet Works Like Hypertension Drug - WebMD, 5/19/03 -
"the DASH diet -- created to fight
high blood pressure -- works just like water pills ... If people eat the DASH diet with low salt intake -- especially older people -- their blood pressure goes down 15 points"
- Fighting Fluid Retention? - Dr. Weil, 9/20/02
News & Research:
Antihypertensive drugs decrease risk of Alzheimer disease: Ginkgo Evaluation
of Memory Study - Neurology. 2013 Aug 2 -
"Secondary longitudinal data analysis of the Ginkgo Evaluation of Memory
Study in older adults at least 75 years of age with normal cognition (n =
1,928) or MCI (n = 320) over a median 6.1-year period ... Hazard ratio for
incident AD dementia among participants with normal cognition was 0.51 in
diuretic (95% confidence interval [CI] 0.31-0.82), 0.31 in ARB (95% CI
0.14-0.68), 0.50 in ACE-I (95% CI 0.29-0.83), 0.62 in CCB (95% CI
0.35-1.09), and 0.58 in BB (95% CI 0.36-0.93) users and was not
significantly altered when mean systolic blood pressure was above 140 mm Hg"
- Note: Sounds like the ARB's left the others in the dust. See
my telmisartan as a first line treatment
- More Evidence That
ARBs Have Cognitive Benefits - Medscape, 3/23/12 -
"After stopping their antihypertensive medications,
the patients were randomly assigned to the ARB candesartan (n = 20), the
angiotensin-converting enzyme inhibitor (ACEI) lisinopril (n = 18), or the
diuretic hydrochlorothiazide (n = 15) ... After adjustment for age and
baseline score on the Mini-Mental State Examination, patients taking
candesartan showed the greatest improvements on tests assessing executive
function ... Our findings further support observational data showing that
ARB use is associated with lower risk of dementia and Alzheimer disease
compared with the use of ACEIs or other antihypertensives ... As reported
previously by Medscape Medical News, Dr. Kehoe and colleagues recently
published a study showing a 53% lower risk for Alzheimer's disease in older
adults prescribed an ARB compared with those prescribed other
Diuretics Associated With Bone Loss In Older Men - Science Daily, 4/14/08 -
"After adjusting for other related factors, the average
annual rate of decline in total hip bone mineral density was -0.33 percent in
non-users, -0.58 percent in intermittent users and -0.78 percent among
Blood Pressure Therapy Dramatically Lowers Cardiovascular Risk - Science
Daily, 3/31/08 - "One group received a tablet containing
benazepril, which is a type of drug called an ACE inhibitor, and amlodipine,
which belongs to a class of drugs known as calcium channel blockers or CCBs. The
other pill combined benazepril and hydrochloro-thiazide, a type of diuretic or
"water pill." The 20 percent reduction in cardiovascular events was observed
with the ACE/CCB combination tablet"
Glycemic Control Reversible When Switching Off Diuretic-Based Therapy -
Medscape, 5/25/07 - "The risk of
new-onset diabetes is also dose dependent, he said, such that at 25-mg
hydrochlorothiazide (HCTZ) there is substantial risk of impairing the glucose
Valsartan Cuts C-Reactive Protein Levels in Prediabetics - Doctor's Guide,
5/22/07 - "In diabetic patients with
abdominal obesity, after 16 weeks of hydrochlorothiazide therapy, median hsCRP
values were increased 16% (4.9 vs 3.7 mg/L at baseline, P <.05) but decreased 9%
in patients on valsartan (3.7 vs 4.1 mg/L at baseline, P <.05) and 5% in
patients on combination therapy"
and Beta-Blocker Use Linked With Increased Risk for Incident Diabetes -
Medscape, 5/8/07 - "the relative risk of
incident diabetes for those taking a thiazide diuretic compared with those not
taking a thiazide was 1.20 (95% confidence interval [CI], 1.08 - 1.33) in older
women; 1.45 (95% CI, 1.17 - 1.79) in younger women; and 1.36 (95% CI, 1.17 -
1.58) in men ... the risk for incident diabetes was also increased in patients
taking beta-blockers relative to those who were not: 1.32 (95% CI, 1.20 - 1.46)
in older women and 1.20 (95% CI, 1.05 -1.38) in men. In younger women, a
category of "other antihypertensives" was used that included beta-blockers, and
their use was associated with an increased risk for 1.46"
Favors First-Line Use of Irbesartan/HCTZ Combo - Medscape, 4/19/07 -
"The US FDA Cardiovascular and Renal
Drugs Advisory Committee recommended extended use of the combination product
irbesartan plus hydrochlorothiazide (Avalide, Bristol-Myers Squibb) for the
first-line treatment of hypertension" - Yeah, if you can get by the side
effects of hydrochlorothiazide plus the increased chance of diabetes.
Irbesartan is a ARB and hydrochlorothiazide is a
diuretic. I'm not a doctor and here I am criticizing those who are but I
still feel that telmisartan (a ARB)/ramipril (a ACE inhibitor) should be the
first time treatment. Click here for
the research. Some doctors claim you can't mix a ARB with an ACE
inhibitor but I couldn't find any evidence of that.
Glucose Increases in Older Adults With Hypertension Regardless of Treatment Type
- Medscape, 11/16/06 - "randomized to
receive treatment with chlorthalidone, amlodipine, or lisinopril to reduce blood
pressure to less than 140/90 mm Hg ... During the first 2 years, the mean
increase is serum glucose levels was 8.5, 5.5, and 3.5 mg/dL among the
chlorthalidone, amlodipine, and lisinopril groups, respectively"
Fasting glucose levels and incident diabetes mellitus in older nondiabetic
adults randomized to receive 3 different classes of antihypertensive treatment:
a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart
Attack Trial (ALLHAT) - Arch Intern Med. 2006 Nov 13;166(20):2191-201 -
"Mean FG levels increased during
follow-up in all treatment groups. At year 2, those randomized to the
chlorthalidone group had the greatest increase (+8.5 mg/dL [0.47 mmol/L] vs +5.5
mg/dL [0.31 mmol/L] for amlodipine and +3.5 mg/dL [0.19 mmol/L] for lisinopril)"
Diuretics: A modern day treatment option? (Review Article) - Nephrology
(Carlton). 2006 Oct;11(5):419-27 - "The
main area of doubt lies in relation to the risk of renal outcomes and of
metabolic outcomes, such as new onset diabetes - where the evidence suggests
that drugs that inhibit the renin-angiotensin system may be more protective than
all other drug classes"
Thiazide Diuretics, Potassium, and the Development of Diabetes. A
Quantitative Review - Hypertension. 2006 Jun 26 -
hypokalemia is associated with increased blood glucose"
Beta-Blocker Use Linked With Increased Risk for Incident Diabetes -
Medscape, 5/8/06 - "The multivariate
risk ratios of developing diabetes associated with taking thiazide diuretics
were 1.20, 1.51, and 1.31 in the NHS I, NHS II, and HPFS, respectively"
Use of Potassium-Sparing Diuretics Cuts AD Risks - Clinical Psychiatry
News, 4/06 - "The risk of developing
AD was significantly smaller in those who took antihypertensive medications
than in those who did not (adjusted hazard ratio [aHR] 0.64). When the
results were broken down by drug class, diuretics showed the greatest
protective effect against AD"
Diuretics Reduce Risk of Death From Congestive Heart Failure - Doctor's
One in Five Patients on Commonly Prescribed Diuretics Have Abnormal Sodium
and Potassium Levels - Doctor's Guide, 1/11/06 -
"In milder cases they can make
people feel below par, cause general weakness and tiredness and sometimes
interfere with the normal rhythm of the heart ... Severe loss of sodium can
make it difficult for people to maintain their blood pressure at a normal
level, causing dizziness, confusion and an increased risk of falls in older
Increased Serum Creatinine More Likely when Nesiritide is Combined with
High-Dose Diuretics - Doctor's Guide, 11/16/05
'Water Pills' May Cut Heart Risks in Diabetes - WebMD, 6/27/05
Patients Who Fail Anti-Hypertensive Monotherapy Respond to Fixed-Dose
Combination of Irbesartan/Hydrochlorothiazide - Doctor's Guide, 5/19/05
High-Dose Hydrochlorothiazide Gets Hard-to-Treat Hypertensive Patients to
Blood Pressure Goal - Doctor's Guide, 5/18/05
Combo Drug Controls Hypertension In Hard-to-treat Patients - Science
Daily, 5/18/05 - "the combination
pill of irbesartan (an angiotensin II receptor blocker) and a diuretic,
hydrochlorothiazide ... the participants' systolic blood pressure (the top
number) dropped an average of 21.5 points, from 154.4 to 132.9 points. Their
diastolic blood pressure (the bottom number) fell an average of 10.4 points,
from 91.3 to 80.9" - Yeah, but what about impotence from the
Linked to Erectile Dysfunction - WebMD, 5/16/05 -
"Men on older high blood pressure
medications (diuretics, beta-blockers) had higher rates and more severe
erectile dysfunction than men on newer medications (calcium antagonists, ACE
inhibitors, angiotensin II receptor blockers)"
Diuretics Best Initial Therapy in Treating High Blood Pressure -
Doctor's Guide, 4/7/05
Water Pill Works Best for High Blood Pressure - WebMD, 4/5/05 -
diuretics, known as water pills, which cost just pennies a pill, are a
better choice for the initial treatment of high blood pressure than the
newer drugs, known as ACE inhibitors and calcium-channel blockers"
- Diuretic Not Suited for Everyone With Heart Failure - HealthDay, 8/4/04
- Telmisartan 40 or 80 mg/Hydrochlorothiazide 12.5 mg Fixed –Dose Combinations Can Thwart Early Morning Blood Pressure Surge - Doctor's Guide, 6/15/04
- Diuretics May Be Underused as First Line Treatment for Patients With Hypertension - Doctor's Guide, 4/5/04
- Chronic Diuretic Use in Heart Failure Patients Called Into Question - Doctor's Guide, 3/9/04
- Diuretics Linked to Increased Mortality in Heart Failure - Medscape, 3/9/04
- Diuretics Appear To Reduce Pulse Pressure Effectively In Older Hypertensive Patients - Doctor's Guide, 11/21/03
- Spironolactone Reduces Blood Pressure in Patients with Resistant Hypertension - Doctor's Guide, 11/4/03
- Hypertension Drug Also Cuts Bone Loss - HealthDay, 9/15/03
- Millions Wasted on High Blood Pressure Medications - WebMD, 9/8/03 - Yeah, but what about the fact the diuretics have to
worst compliance! - Ben
- Perindopril/Indapamide Therapy May Help Reduce Dementia Risk In Patients With Cerebrovascular Disease - Doctor's Guide, 6/16/03
- FDA Grants Marketing Approval for Benicar HCT (Olmesartan Medoxomil-Hydrochlorothiazide) Treatment For Hypertension - Doctor's Guide, 6/9/03
- Low-Dose Diuretics Most Effective Way To Treat Hypertension - Doctor's Guide, 5/21/03
- Diuretic Use Linked to End-Stage Renal Disease [ESRD] - Medscape, 5/16/03 -
"We're concerned that there could be a long time lag between use of thiazide diuretics and ESRD, even as long as 10 to 15 years"
- Maternal Diuretics In Pregnancy May Be Linked To Schizophrenia In Offspring - Doctor's Guide, 3/14/03
- Which Blood Pressure Drug Is Best? - HealthDay, 2/12/03 -
"The differing results could have been due to the difference in the ethnic makeup of the two trials, Reid says. "Thirty percent of the ALLHAT subjects were black Americans, who are known not to respond to ACE inhibitors," ... Almost all the 6,083 people in the Australian trial were white. Blood pressure reduction was the same
in those who took a diuretic and those who took an ACE inhibitor. The incidence of stroke was the same in both groups, but the number of deaths from cardiovascular disease was 11 percent lower in the ACE inhibitor group ... There is general agreement that almost all people with high blood pressure need to take to
more than one drug"
- Blood Pressure Control -- Timing Matters - WebMD, 1/24/03 -
"Researchers found that the diuretic and
calcium-channel blocker were effective around the clock. The beta-blocker was the least effective of the four drugs overall and it had no effect on blood pressure during the night or in the early morning hours. ACE inhibitors actually worked
best while the study participants were sleeping, but had little effect on blood pressure during the day"
- Spironolactone Augments Angiotensin-Converting Enzyme Inhibitors, Benefits Left Ventricular Function - Doctor's Guide, 1/6/03
- Thiazide Diuretics Less Damaging to Bone Than Loop Diuretics - Doctor's Guide, 1/2/03
BP Lowering May Halt Descent Into Dementia - Clinical Psychiatry News, 12/02 -
"Dr. Hansson served as cochair of SCOPE, a 15-nation study in which 4,937 mildly hypertensive patients
aged 70-89 were randomized to the angiotensin-receptor blocker candesartan or diuretic-based therapy. Serial Mini-Mental Status Exams (MMSEs) conducted during more than 18,000 patient-years of
follow-up demonstrated that among individuals with a baseline MMSE of 24-28—indicative of normal to slightly impaired cognitive function—those in the candesartan arm had a mean 0.5-point
decline in MMSE scores during follow-up, compared with a 6-point drop in those on a diuretic. The cognitive benefit was even more pronounced in patients over age 85"
- Diuretics Best for High Blood Pressure - WebMD, 12/17/02 -
"diuretics should be the top choice for combating high blood pressure"
- Yeah, but what about impotence and other quality of life issues. If people don't take them because of the side effects, they aren't doing much good. See:
- Reproducibility Of Responses To Hydrochlorothiazide Variable For Individuals - Doctor's Guide, 12/11/02
- Diuretics Associated with Increased Mortality Risk in Acute Renal Failure - Doctor's Guide, 11/27/02
- Low Dietary Or Serum Potassium Risk Factor For Stroke - Doctor's Guide, 8/27/02 -
"Diuretic users had an increased risk
for stroke which was associated with lower serum potassium (relative risk 2.5;P<0.0001). People who did not use diuretics had an increased risk for stroke if they had low dietary potassium intake (relative risk 1.5;P<0.005)"
Patient Compliance with Antihypertensive Therapy Appears Longer
for Those Taking Angiotensin II Antagonists - Doctor's
Guide, 7/18/02 - "The researchers found that the
class of drug had a statistically significant effect on the patients'
persistence of compliance. Angiotensin II antagonists had the highest rate
of persistence followed by ACE inhibitors, calcium channel blockers,
beta-blockers, and diuretics"
- Losartan Plus Hydrochlorothiazide Reduces Essential Hypertension - Doctor's Guide, 6/26/02
- Telmisartan/Hydrochlorothiazide Combination Superior To Telmisartan Alone For Hypertension - Doctor's Guide, 5/13/02
- Blood Pressure Combo [ACE inhibitor & diuretic] Lowers Risk of Stroke - WebMD, 9/27/01
- ACE Inhibitor Plus Diuretic Combo Best for American Indians - Doctor's Guide, 7/11/01
- Low-Dose Perindopril/Indapamide Combination More Effective Than Irbesartan Alone - Doctor's Guide, 6/21/01
- ACE Inhibitor/Diuretic Combination Treatment Protects Against Second Stroke - Doctor's Guide, 6/18/01
- Blood Pressure Drugs Cut Stroke Risk - Intelihealth, 6/17/01 -
"giving stroke patients blood pressure pills and diuretics could halve the chance of their
suffering another stroke"
- Telmisartan With Hydrochlorithiazide Controls Hypertension - Doctor's Guide, 5/18/01 -
"after eight weeks on the FDC, both SBP/DBP dropped by 7.4/3.5 mmHg, compared with the telmisartan 40 mg monotherapy"
- Black Hypertensive Patients Benefit From Combined Angiotensin II Antagonist + Thiazide - Doctor's Guide, 4/6/01 -
"The combination gave a mean reduction from baseline of 13.3 mmHg, compared with only 4.6
mmHg for telmisartan 80 mg alone and 5.2 mmHg for HCTZ alone (p<0.01). The active treatments produced no more side-effects than placebo did"
- A Water Pill a Day Can Keep a Stroke Away, Study: People With High Blood Pressure Need to Be on a Diuretic - WebMD, 1/8/01 -
""If I had high blood pressure, I would take a diuretic as a first-line
treatment drug," says study author Bruce M. Psaty, MD, PhD. He is a professor of medicine and epidemiology at the University of Washington in Seattle."
- Study: Diuretics Help Stop Strokes - Intelihealth, 1/8/01
- FDA Approves Micardis HCT (Telmisartan/Hydrochlorothiazide) For Hypertension - Doctor's Guide, 11/21/00 (Micardis is and ARB, hydrochlorothiazine is a diuretic)
- Nutrient Depletion Checklist: Thiazide Diuretics - Nutrition Science News, 11/00
- Atacand HCT (Candesartan Cilexetil-Hydrochlorothiazide), Anti-Hypertensive, Now Available In US - Doctor's Guide, 10/26/00
- Chlorthalidone Superior To Doxazosin As First-Line Antihypertensive - Doctor's Guide, 4/4/00
- ACC Issues Clinical Alert On Use Of Cardura (Doxazosin) For Hypertension - Doctor's Guide, 3/16/00
- Potassium-Magnesium Citrate Effective In Correcting Thiazide-Induced Side Effects - Doctor's Guide, 11/13/98
- FDA-Approved Diovan HCT Combines Two Hypertension Drug Classes - Doctor's Guide, 3/10/98
- Diuretic Withdrawal Can Do More Harm Than Good- Doctor's Guide, 8/22/97
- Diuretics Significantly Lower Risk Of Heart Failure - Doctor's Guide, 7/15/97