Diuretics are a [long-standing] antihypertensive drug. Its mechanism of lowering blood pressure is well understood. We often compare blood vessels to water pipes and heart to water pumps. The blood is the water in the water pipes.
Some people suffer from hypertension, that is, there is too much water in the water pipe and the pressure on the water pipe will be great. If we discharge some water from the pipe, the pressure will drop.
Diuretics play a role in draining water, draining more water from blood vessels, reducing blood volume and blood pressure.
However, among hypertension patients in our country, the use of diuretics is far less extensive than that of other three types of antihypertensive drugs. Why?
Disadvantages of diuretics
Long-term use of large doses of diuretics can cause a series of adverse reactions, such as increased uric acid, glucose and lipid metabolism disorders, increased new diabetes, etc.
The process of using diuretics is more troublesome, requiring regular potassium supplement and regular blood sampling to monitor blood potassium.
In addition, the large amount of urine and frequent urination also bring troubles to patients.
Which patients are suitable for diuretics?
With these shortcomings, is diuretics worthless?
Of course not. Diuretics are of great value to the following types of hypertension patients:
Elderly hypertensive patients
Elderly hypertension is often accompanied by water and sodium retention. Diuretics can solve this problem well.
Salt sensitive hypertension
Hypertension related to eating too much salt at ordinary times, taking diuretics can expel excessive sodium from the body.
Poor cardiac function
Diuretics are indispensable drugs to reduce the burden on the heart. Diuretics are more suitable for patients with lower limb edema due to poor cardiac function.
Combined medication
Patients who use 3 kinds and more than 3 kinds of hypertension drugs may need to use diuretics. If the two kinds of drugs cannot control blood pressure well, hypertension is stubborn and often accompanied by water and sodium retention. At this time, the effect of adding diuretics is usually better.
What are the commonly used diuretics?
Diuretics used to lower blood pressure mainly include two kinds:
- One is thiazide diuretics, hydrochlorothiazide commonly used clinically; The second is a new diuretic, indapamide is commonly used clinically.
There are also two kinds of diuretics that are not used as conventional recommended drugs. One is loop diuretics such as furosemide, which have too strong diuretic effect and are seldom used. They are generally used in hypertension patients with heart failure and in hypertension emergencies. Second, potassium-preserving diuretics such as spironolactone have too weak diuretic and antihypertensive effects and are usually used in combination with other diuretics to prevent hypokalemia.
Precautions in using diuretics
Common adverse reactions of diuretics include:
Disorder of water electrolyte metabolism
Diuretics reduce blood pressure by promoting kidney salt discharge and drainage, so water and electrolyte disorders are easy to occur. The most common is hypokalemia.
Hypokalemia is quite harmful to the body. Generally speaking, for patients taking diuretics, doctors will supplement potassium appropriately or combine it with potassium-preserving diuretics when taking diuretics, and regularly check blood potassium.
Glucose and lipid metabolism disorder
Diuretics have an impact on the metabolism of blood sugar and blood lipid, so patients with hyperlipidemia and hyperglycemia should use them with caution. Especially when diuretics and receptor blockers are used in combination, it is more likely to cause impaired glucose tolerance, and the combination is not selected as far as possible.
Elevated serum uric acid
Diuretics are forbidden for gout patients to reduce blood pressure, because it will lead to obvious aggravation of gout.