1. Diuretics best given Diuretics for high blood pressure

ExamplesThiazide diureticsGeneric NameBrand Name

chlorothiazideDiuril, Clorpres, Tenoretic, Thalitone, Capozide, Dyazide, Hyzaar, Lopressor HCT, Maxzide, Prinzide, Bumex, Lasix, Demadex, Aldactazide, Aldactone, Dyazide, Maxzide, Zaroxolyn

chlorthalidoneand chlorthalidone combinationsDiuril, Clorpres, Tenoretic, Thalitone, Capozide, Dyazide, Hyzaar, Lopressor HCT, Maxzide, Prinzide, Bumex, Lasix, Demadex, Aldactazide, Aldactone, Dyazide, Maxzide, Zaroxolyn

hydrochlorothiazideand hydrochlorothiazide combinationsDiuril, Clorpres, Tenoretic, Thalitone, Capozide, Dyazide, Hyzaar, Lopressor HCT, Maxzide, Prinzide, Bumex, Lasix, Demadex, Aldactazide, Aldactone, Dyazide, Maxzide, Zaroxolyn

indapamideDiuril, Clorpres, Tenoretic, Thalitone, Capozide, Dyazide, Hyzaar, Lopressor HCT, Maxzide, Prinzide, Bumex, Lasix, Demadex, Aldactazide, Aldactone, Dyazide, Maxzide, Zaroxolyn

Loop diureticsLoop diuretics are prescribed for people who also haveheart failure, kidney problems, or swelling in their legs (edema). But they are rarely prescribed for people who have high blood pressure alone. Loop diuretics quickly increase urine output for a few hours.Generic NameBrand Name

bumetanideBumex, Lasix, Demadex, Aldactazide, Aldactone, Dyazide, Maxzide, Zaroxolyn

furosemideBumex, Lasix, Demadex, Aldactazide, Aldactone, Dyazide, Maxzide, Zaroxolyn

torsemideBumex, Lasix, Demadex, Aldactazide, Aldactone, Dyazide, Maxzide, Zaroxolyn

Potassium-sparing diureticsPotassium-sparing diuretics, unlike most other diuretics, do not cause potassium levels to drop. Rather, they may lead to high potassium levels.Generic NameBrand Name

amilorideand amiloride combinationsAldactazide, Aldactone, Dyazide, Maxzide, Zaroxolyn

spironolactoneand spironolactone combinationsAldactazide, Aldactone, Dyazide, Maxzide, Zaroxolyn

triamtereneand triamterene combinationsAldactazide, Aldactone, Dyazide, Maxzide, Zaroxolyn

OtherGeneric NameBrand Name

metolazoneZaroxolyn

How It WorksDiuretics cause the kidneys to remove moresodiumand water from the body which helps to relax the blood vessel walls, thereby lowering blood pressure.Diuretics often are combined with otherhigh blood pressuremedicines. Some of the brand names listed here are a combination of a diuretic and another medicine. Using both a diuretic and another medicine often works well because diuretics can enhance the effect of the other medicines and sometimes prevent the fluid retention that can occur.Why It Is UsedDiuretics are recommended as the first line of treatment for high blood pressure. They are usually recommended as one of at least two medicines to control high blood pressure.Diuretics are especially beneficial in African Americans, older adults, people who are overweight, and people who have heart failure.Because diuretics may raise cholesterol, makediabetesworse, causegout, and make some types ofheart diseaseworse, they need to be used carefully.How Well It WorksDiuretics reduce the risk of heart disease,heart attack, andstrokeby reducing blood pressure.Side EffectsSide effects of diuretics include: Increased thirst. Increased urination for a few days after beginning the medicine (thiazide diuretics). Reduced levels of potassium, magnesium, and sodium in the blood. Very low levels of potassium can lead to serious irregular heartbeats (arrhythmias). Increased levels of uric acid (which may lead to gout), calcium, blood sugar (which may complicate control of diabetes), and cholesterol. Weakness. Erection problems (impotence). Excess fluid loss from the body (dehydration) andfaintingat higher doses, especially in older adults. Dry mouth. Tooth decay (dental caries). Interaction with other medicines, such as nonsteroidal anti-inflammatory drugs (NSAIDs), certain cholesterol-lowering drugs (such ascholestyramine), andlithium, a medicine used to treat certain mental illnesses.See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)2. Mechanism of action in lowering blood pressureMechanism of actionClassification of common diuretics and their mechanisms of action:ExamplesMechanismLocation (numbered in distance along nephron)

ethanol,waterinhibitsvasopressinsecretion1.

AcidifyingsaltsCaCl2, NH4Cl1.

Argininevasopressinreceptor2antagonistsamphotericin B,lithium citrateinhibit vasopressin's action5.collecting duct

AquareticsGoldenrod,JuniperIncreases blood flow in kidneys1.

Na-H exchangerantagonistsdopamine[9]promote Na+excretion2.proximal tubule[9]

Carbonicanhydraseinhibitorsacetazolamide,[9]dorzolamideinhibit H+secretion, resultant promotion of Na+and K+excretion2:proximal tubule

Loop diureticsbumetanide,[9]ethacrynic acid,[9]furosemide,[9]torsemideinhibit theNa-K-2Cl symporter3. medullarythick ascending limb

Osmotic diureticsglucose(especially in uncontrolled diabetes),mannitolpromote osmotic diuresis2.proximal tubule,descending limb

Potassium-sparing diureticsamiloride,spironolactone,triamterene,potassium canrenoate.inhibition ofNa+/K+ exchanger: Spironolactone inhibitsaldosteroneaction, Amiloride inhibitsepithelial sodium channels[9]5.cortical collecting ducts

Thiazidesbendroflumethiazide,hydrochlorothiazideinhibit reabsorption byNa+/Cl-symporter4.distal convoluted tubules

Xanthinescaffeine,theophylline,theobromineinhibit reabsorption of Na+, increaseglomerular filtration rate1. tubules

Chemically, diuretics are a diverse group of compounds that either stimulate or inhibit varioushormonesthat naturally occur in the body to regulate urine production by the kidneys.Herbal medicationsare not inherently diuretics. They are more correctly calledaquaretics.

3. The Adverse effects of that diureticsThe main adverse effects of diuretics arehypovolemia,hypokalemia,hyperkalemia,hyponatremia,metabolic alkalosis,metabolic acidosisandhyperuricemia.[9]Adverse effectDiureticsSymptoms

Hypovolemia loop diuretics[9] thiazides[9] lassitude[9] thirst[9] muscle cramps[9] hypotension[9]

hypokalemia acetazolamides[9] loop diuretics[9] thiazides[9] muscle weakness[9] paralysis[9] arrhythmia[9]

Hyperkalemia amilorides[9] triamterenes[9] spironolactone[9] arrhythmia[9] muscle cramps[9] paralysis[9]

hyponatremia thiazides[9] furosemides[9] CNS symptoms[9] coma[9]

metabolic alkalosis loop diuretics[9] thiazides[9] arrhythmia[9] CNS symptoms[9]

metabolic acidosis acetazolamides[9] amilorides[9] triamterene[9] Kussmaul respirations[9] muscle weakness neurological symptoms[9] lethargy coma seizures stupor

hypercalcemia thiazides[9] gout tissuecalcification[9] fatigue depression confusion anorexia nausea vomiting constipation pancreatitis increased urination

hyperuricemia thiazides[9] loop diuretics[9] gout[9]

4. Captopril combine with spironolactoneSpironolactone alone in full dosage failed to correct hypertension in a patient with Conn's syndrome and renal Impairment, although the previously increased total exchangeable sodium fell to normal and the previously suppressed plasma angiotensin II did not rise above the normal range. Addition of the converting enzyme inhibitor captopril reduced plasma angiotensin II to very low levels, with a slight further fall in exchangeable sodium. Blood pressure was well controlled. Because hypertension in Conn's syndrome resistant to spironolactone usually also responds poorly to removal of the adenoma, and is difficult to treat with conventional hypotensive agents, the combination of a converting enzyme inhibitor with a potassium conserving diuretic is worthy of trial in such cases.5. Clinical indication of diureticsInmedicine, diuretics are used to treatheart failure,liver cirrhosis,hypertensionand certainkidney diseases. Some diuretics, such asacetazolamide, help to make theurinemorealkalineand are helpful in increasing excretion of substances such asaspirinin cases ofoverdoseor poisoning. Diuretics are often abused by sufferers ofeating disorders, especiallybulimics, in attempts at weight loss.[1]The antihypertensive actions of some diuretics (thiazidesandloop diureticsin particular) are independent of their diuretic effect. That is, the reduction in blood pressure is not due to decreased blood volume resulting from increased urine production, but occurs through other mechanisms and at lower doses than that required to produce diuresis.Indapamidewas specifically designed with this in mind, and has a larger therapeutic window for hypertension (without pronounced diuresis) than most other diuretics.