Diuretics

Diuretics (diuretics) are the substances that stimulate the kidneys to increase urine formation and thus helping to remove liquids and minerals from the body (increase urine output).

Diuretics are divided into three groups depending on application of their action, which depends on the severity of the natriuretic effect, expressed as a percentage of sodium excreted from the total amount of sodium filtered in the glomerulus.

Potent diuretics (causing more than 15-20% excretion of filtered sodium): 

• Organic mercury compounds     (Mersalil, is currently used in clinical practice);
• acid derivatives sulfamonlantranilovoy     (Furosemide, bumetanide, piretanid, torasemide);
• phenoxyacetic acid derivatives     (Ethacrynic acid, indakrinon).

Diuretics with moderate natriuretic effect (causing excretion of 5-10% of filtered sodium):

• benzotiadiazin derivatives (thiazides and gidrotiazidy)     (Hlortiazid, hydrochlorothiazide, bendroflumethiazide, politiazid, cyclothiazide);
• heterocyclic compounds similar to the mechanism of tubular action of thiazide diuretics     (Chlorthalidone, metolazone, klopamid, indapamide, ksipamid).

Light diuretics (causing excretion of less than 5% of filtered sodium):

• Potassium-sparing diuretics     (Amiloride, triamterene, spironolactone);
• carbonic anhydrase inhibitors     (Acetazolamide);
• osmotic diuretics     (Mannitol, urea, glycerol).

Diuretics are used to treat high blood pressure, congestive heart failure and other diseases during which the body accumulates too much liquid. All diuretics have the potential side effects, which generally include the leaching of potassium and sodium from the body, dangerous drug interactions and allergic reactions. Older patients also may experience side effects such as blood clots and shock, but it is quite rare. Thiazide diuretics are sparing diuretic, which reduces the risk of dizziness, fainting or other side effects associated with excessive fluid loss. Expert in the study of hypertension in elderly patients has recently stated that “Thiazide diuretics (described on this page) is almost certainly safer than all other drugs to treat high blood pressure”.

If you have hypertension, the best way to get rid of the need for medication are measures such as changes in diet, weight loss, regular exercises and reduced intake of salt and alcohol. A slight increase of pressure can be controlled with proper diet and exercise. If these measures do not lead to sufficient reduction of pressure and you need medication, you should select hydrochlorothiazide and start with a small dose – 12.5 mg per day. The use of this drug is also the fact that it is cheaper than all other antihypertensive drugs.

There is compelling evidence that Thiazide diuretics such as hydrochlorothiazide, significantly reduce the rate of leaching of minerals from the bone in both men and women, because they reduce the amount of calcium that appears in the urine. More and more researchers are also inclined to believe that these drugs reduce the risk of fractures.

Diuretics have been used to treat hypertension and cardiovascular disease over 50 years. Diuretic drugs are one of the most important groups of drugs to treat hypertension. These tools help to lower blood pressure, forcing the body to get rid of excessive salt and water. Purification is carried out by kidneys through urine. Various groups of diuretics have different effect on the kidney: they remove water and salt from the body, but have strong or mild side effects. After a couple of months of taking diuretic tablets, the patient’s body gets used to the reduced amount of liquid. However, the effect of reducing blood pressure remains due to the weakening of resistance to blood flow.

Diuretics are the drugs to treat hypertension in the following situations:

• amongst elderly patients (see the article “What medications are prescribed for hypertension amongst elderly patients”)
• with isolated systolic hypertension (i.e., when only “top” blood pressure is high)
• in the case of concomitant heart failure
• in the case of osteoporosis

Numerous studies have shown that water pills greatly reduce the incidence of complications amongst hypertensive patients:

• myocardial infarction – for 14-16%
• stroke – by 38-42%