There are many mechanisms of hypertension, one of which is the increase of blood volume caused by excessive sodium intake and water and sodium retention. Diuretics can reduce volume load by promoting sodium ion excretion, which is beneficial to lowering blood pressure. Commonly used diuretics include strong diuretics such as furosemide and torasemide, medium diuretics such as hydrochlorothiazide and indapamide, and weak diuretics such as spironolactone and triamcinolone acetonide. When used alone to lower blood pressure, strong diuretics are rarely used, mainly medium diuretics. In the process of depressurization, attention should be paid to:
① Diuretics can cause metabolic disorders, including abnormal blood sugar and blood lipid. The incidence is related to the dosage of diuretics, which usually occurs in patients who use large doses of diuretics for a long time. Controlling the dosage of diuretics can reduce the influence on metabolism. Taking hydrochlorothiazide as an example, the daily dose is controlled at 6.25-25mg, which can control blood pressure and reduce the occurrence of adverse reactions.
② Some patients with hypertension may be complicated with hyperuricemia. Long-term elevation of serum uric acid can induce gout and aggravate renal damage. Thiazine diuretics such as hydrochlorothiazide and indapamide may increase uric acid and increase the risk of gout while lowering blood pressure. Therefore, thiazide diuretics are prohibited in patients with gout, and it is suggested that patients with hyperuricemia use other antihypertensive drugs.
(3) Diuretics can cause abnormal blood potassium, hydrochlorothiazide, indapamide and other drugs can promote potassium ion excretion, and long-term application can cause hypokalemia; Spironolactone, triamterene and other drugs have the effect of potassium preservation, and long-term use may cause hyperkalemia. No matter whether blood potassium increases or decreases, it will have adverse effects. Therefore, blood potassium should be monitored after 2-4 weeks of diuretic use.
④ When diuretics are used alone, their antihypertensive effect is limited, and the adverse reactions may increase when the dosage is increased. Therefore, diuretics are usually used in combination with other antihypertensive drugs, including calcium channel blockers (antihypertensive drugs such as Horizon), ACEI (antihypertensive drugs such as Puli) and ARB (antihypertensive drugs such as Sartan), which can not only increase the antihypertensive effect, but also reduce the adverse reactions between them; Because the combination with beta blockers (such as metoprolol and bisoprolol) can increase the risk of diabetes, it is not recommended to use these two antihypertensive drugs with obesity, abdominal obesity, pre-diabetes and other high-risk groups of diabetes and diabetic patients.
To sum up, diuretics reduce blood pressure by promoting sodium ion excretion, and the incidence of adverse reactions of strong and large doses of diuretics is high, so it is appropriate to use diuretics with moderate and weak effects (such as hydrochlorothiazide) and small and medium doses (such as 6.25-25mg hydrochlorothiazide per day) when lowering blood pressure; Because diuretics alone have limited antihypertensive effect, they are often used in combination with other drugs, such as Puli, Sartan and Diping, which can increase antihypertensive effect and reduce adverse reactions.
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Many patients with hypertension are taking diuretics. It may be that diuretics don't know what they are, that is, hydrochlorothiazide taken by many hypertensive patients. In fact, many hypertensive patients do not just take a diuretic to lower their blood pressure, but take a compound preparation containing diuretics, such as irbesartan hydrochlorothiazide tablets. So, what kind of antihypertensive drug is diuretic? Let's talk to Dr. Zhang.
The main mechanism of diuretics to reduce blood pressure is to reduce blood volume through sodium excretion and diuresis. Diuretics used to control blood pressure are mainly thiazide diuretics, such as hydrochlorothiazide and indapamide. Many large-scale clinical studies show that diuretics can reduce blood pressure and stroke caused by hypertension. The use of low-dose diuretics, such as hydrochlorothiazide 6.25mg-25mg, has little effect on metabolism, and can get twice the result with half the effort when combined with other antihypertensive drugs.
Diuretics are suitable for elderly patients with hypertension, isolated systolic hypertension, hypertension with cardiac insufficiency and refractory hypertension. Diuretics are usually used in small doses because their adverse reactions are highly dose-related. Thiazine diuretics are the most commonly used antihypertensive drugs, but they are also easy to cause the decrease of blood potassium and the increase of uric acid, which must be closely monitored.
At present, among the five most commonly used antihypertensive drugs in clinical hypertension patients, diuretics can be said to be the big brother. Diuretics have been used as antihypertensive drugs for more than half a century. Up to now, diuretics are still recommended as first-line drugs in clinic, mainly based on the good antihypertensive effect of diuretics and the good synergistic antihypertensive effect with other drugs.
Before talking about the precautions of taking diuretics and antihypertensive drugs, let's talk about the "good" of diuretics.
In fact, diuretics and antihypertensive drugs are often used too little, because they are older and cheaper. Therefore, when other antihypertensive drugs have poor antihypertensive effect, they are often used as a "supporting role" as a combination drug, but in fact diuretics have good antihypertensive effect and high safety for long-term medication. In this year's guidelines published in the United States, diuretics are further emphasized.
In the aspect of drug control of hypertension, diuretics can be used as the first choice for the initial treatment of hypertension without drug contraindications. In clinical application, diuretics are especially suitable for the control of senile hypertension, salt-sensitive hypertension, heart failure complicated with hypertension, obese people and refractory hypertension. Therefore, in the use of drugs for hypertension, it is incorrect to think that diuretics are not good because they are cheap, not high-end antihypertensive drugs. When diuretics are used well, they can still solve some problems that other drugs can't solve.
At present, there are three main types of diuretics used in clinic, namely loop diuretics, thiazide diuretics and potassium-preserving diuretics. These three different drugs are different. For the treatment of hypertension, thiazide diuretics such as hydrochlorothiazide and indapamide belong to this category, and loop diuretics are powerful diuretics, including furosemide and bumetanide. Potassium-preserving diuretics belong to aldosterone receptor antagonists, mainly spironolactone and eplerenone, which belong to weak diuretics and are mainly used for the prevention of hypokalemia and the combination of refractory hypertension.
Diuretics have good antihypertensive effect and clear cardiovascular protection, but they are certainly not perfect antihypertensive drugs. Even drugs have side effects, and diuretics are no exception. Therefore, there are many things to pay attention to during taking diuretics, mainly in the following aspects-
1. Pay attention to the increase of serum uric acid. No matter what type of diuretic, although it has different action sites on renal tubules, it generally has adverse effects on the excretion of uric acid in blood. Therefore, long-term use of diuretics may cause the problem of high uric acid. Generally speaking, it is not recommended that patients with hyperuricemia gout use diuretics as much as possible. Generally speaking, low-dose diuretics have little effect on serum uric acid. If you really need to take diuretics, it is enough to choose the dosage reasonably and monitor uric acid level regularly, so don't worry too much about taking them.
2. Pay attention to possible electrolyte disorders. Thiazine diuretics can promote the excretion of sodium ions, improve the retention of water and sodium, and also promote the excretion of potassium ions, so there is a risk of hypokalemia, while potassium-preserving diuretics have the function of preserving potassium and expelling sodium, which may cause the risk of hyperkalemia. Therefore, in the process of taking diuretics, we should pay attention to the monitoring of blood potassium level. For patients with hyperkalemia or renal insufficiency, aldosterone receptor antagonist diuretics should be banned, and for thiazide diuretics, the incidence of hypokalemia can be reduced by combined use of sartan or pril drugs.
3. Pay attention to abnormal glucose metabolism. Diuretics may also cause abnormal glucose metabolism. Therefore, during the long-term use of diuretics, attention should also be paid to the monitoring of blood sugar levels. If it is not necessary, it is not recommended to use diuretics together with beta blockers to reduce the greater impact of the superposition of the two drugs on glucose metabolism.
The possible adverse reactions and precautions of diuretics may seem scary at first glance, but in fact, the risk and probability of adverse drug reactions are often closely related to the dosage of drugs. If you choose low-dose diuretics, the risk of adverse reactions is actually not great. However, in the case of poor single drug control, Pulitzer, sartans and calcium antagonists are combined with thiazides.
Dr. Wang's most frequent outpatient is hypertension. Why is hypertension the first? Because one in every four adults is hypertensive, such a huge base naturally leads to the largest number of hypertensive patients in cardiovascular clinics.
The basic treatment of hypertension is a healthy lifestyle, and Dr. Wang will mention it almost every day: quitting smoking and drinking, eating with low salt, low fat and low sugar, insisting on aerobic exercise, controlling weight, regular work and rest, and being happy.
However, most hypertensive patients can't achieve normal blood pressure through a healthy lifestyle, so they can only control their blood pressure through antihypertensive drugs, because only by effectively controlling blood pressure can we reduce the malignant consequences such as cerebral hemorrhage, cerebral infarction, myocardial infarction, heart failure and renal failure.
At present, there are five commonly used antihypertensive drugs: Horizon, Sartan, Puli, lol, diuretics, and several other antihypertensive drugs. There are hundreds of antihypertensive drugs on the market.
One of the five antihypertensive drugs is called diuretic, and hydrochlorothiazide is the most commonly used one. Although diuretics are routine antihypertensive drugs, we seldom use diuretics to reduce blood pressure when we encounter hypertension in clinic. In most cases, when other antihypertensive drugs are ineffective, diuretics are used to lower blood pressure, or hypertension complicated with heart failure may also be used.
When diuretics are combined with Dipine, Sartan or Pupli, the antihypertensive effect will be as good as 1+ 1 2. Therefore, in recent years, there are antihypertensive drugs that directly combine diping or sartan with diuretics, which not only has a good antihypertensive effect, but also can reduce its side effects. What should I pay attention to when taking diuretics for a long time?
1, which will lead to electrolyte disorder.
For example, it will cause low potassium, low sodium and low chlorine, so check the electrolyte regularly, especially when you feel weak in both lower limbs or general weakness.
2. It may lead to an increase in uric acid and blood sugar.
Diuretics have a certain effect on glucose and lipid metabolism, and should be used with caution in patients with diabetes, hyperlipidemia, hyperuricemia, gout and renal insufficiency.
In short, at present, for patients with simple hypertension, we do not advocate the use of diuretics to reduce blood pressure. If diuretics are used, they are usually used together with other antihypertensive drugs, with better effect and less side effects.
Many elderly patients who have been taking diuretics for a long time have not monitored electrolytes. Some patients take diuretics such as indapamide and furosemide tablets, and severe hypokalemia may lead to malignant arrhythmia. ...
When taking medicine in the morning, it is best to take it at the same time every day. Slow blood flow and high blood viscosity at night will increase the risk of thrombosis.
3. It is not suitable for diarrhea. Because diarrhea can concentrate blood and increase blood viscosity, taking medicine will increase the incidence of myocardial infarction and cerebral infarction.
4. Careful use of diuretics in gout patients will increase the frequency of gout attacks.
Diuretics have been used for antihypertensive treatment for more than half a century. Relevant guidelines at home and abroad fully affirmed the position of diuretics in antihypertensive treatment and regarded them as the basic drugs for the treatment of refractory hypertension.
Diuretics are the first choice of antihypertensive drugs. Because these drugs are cheap and effective, and have no drug resistance, they can resist water and sodium retention according to the pathogenesis, eliminate edema caused by other antihypertensive drugs, and combine with many drugs to improve the curative effect.
Main adaptive groups
Diuretics are suitable for the initial and maintenance treatment of most patients with hypertension without contraindications, especially for elderly patients with hypertension, refractory hypertension, heart failure complicated with hypertension and so on.
Diuretics are rarely used alone and are often used in combination as basic drugs. Because single drug therapy can only make a small number of patients with hypertension reach the standard, most patients need combined drugs. Studies have shown that the combination of low-dose diuretics with other antihypertensive drugs has more obvious antihypertensive effect, fewer adverse reactions and more clinical benefits than the single full-dose medication.
Patients with hypertension must be cautious when using diuretics, paying special attention to the following points:
1. Thiazines, a potassium diuretic, can cause hypokalemia. Long-term users should regularly monitor blood potassium and supplement it appropriately. It is forbidden for gout patients, and should be used with caution for those with hyperuricemia and obvious renal insufficiency.
2. Because diuretics have certain effects on blood potassium, blood lipid, blood sugar, blood uric acid and sexual function, patients who often take diuretics should go to the hospital to check the above indicators in order to find abnormalities in time.
3, diuretics are generally recommended to be taken in the morning, not before going to bed at night, so as not to affect sleep. Pay attention to the urine volume after use.
4, avoid drinking coffee, caffeine will lead to potassium metabolism disorder in the body, increase kidney blood flow, accelerate liquid discharge, so people will go to the toilet frequently after drinking coffee. If you take diuretics at the same time, your body will lose a lot of fluid.
5, avoid drinking and strenuous exercise, exercise changes slowly.
6, without the doctor's permission, shall not be arbitrarily increase or decrease the dose.
Tips: Long-term use of diuretics will lead to electrolyte disorder, hyperuricemia, hyperglycemia, hyperlipidemia and other adverse reactions. When you feel unwell or have serious adverse reactions after taking diuretics, you need to go to the hospital in time.
Diuretics are also one of the five most commonly used antihypertensive drugs in clinic, mainly including thiazide diuretics and their compound preparations with other antihypertensive drugs, and indapamide sustained-release tablets, which have the dual functions of dilating tubes and diuresis. After using diuretic antihypertensive drugs, electrolyte disorder and abnormal uric acid metabolism may occur, especially in the elderly, so we should pay attention to the selection of indications, regular monitoring and review.
First of all, diuretics are mainly suitable for patients with hypertension, heart failure and heavy taste with stubborn blood pressure. , and often combined with other antihypertensive drugs to play the role of 1+ 1 >: 2, and there are also some compound preparations such as Wen (valsartan/dichlorothiazide), Haijieya (losartan/dichlorothiazide), Ambono (irbesartan/dichlorothiazide) and so on. This will get twice the result with half the effort.
However, the most common side effect after using diuretics is electrolyte disorder, especially after using diuretics and calcium antagonists (such as amlodipine) or using indapamide sustained-release tablets, attention should be paid to regularly reviewing electrolytes. After diuretics are combined with ACEI or ARB antihypertensive drugs, the probability of hypokalemia is slightly lower (ACRI and ARB drugs have the effect of preserving potassium), but electrolytes should also be checked regularly.
Secondly, the biggest problem after using diuretics is that it may lead to the increase of uric acid and induce gout. Therefore, if it is an acute gout patient, diuretics are prohibited; If it is only a general patient or asymptomatic hyperuricemia, the change of uric acid level should be monitored after using diuretics. In addition, long-term use of diuretics may lead to disorder of blood lipid and blood glucose metabolism, so we should pay attention to dynamic monitoring. If you have severe heart failure and renal failure, you should use diuretics such as furosemide, and pay more attention to electrolyte disorder.
Others. It may cause insufficient blood volume and postural hypotension. Generally, the problem is not big.
In a word, using diuretics well will get twice the result with half the effort, but long-term application should pay attention to its side effects.
Diuretics are one of the basic drugs for treating hypertension, and thiazide diuretics are commonly used. However, in the treatment of hypertension, diuretics are generally not used alone, but usually combined with other antihypertensive drugs to increase the antihypertensive effect.
Diuretics mainly reduce blood pressure by expelling sodium ions, reducing vascular volume and peripheral circulation resistance, especially for the elderly with edema and heart failure. Diuretics not only lower blood pressure, but also produce some side effects, such as electrolyte metabolism disorder, gout attack and aggravated renal function damage.
So everyone should use it under the guidance of a professional doctor. For people with electrolyte disorder, hyperuricemia, gout and renal insufficiency, diuretics should be avoided as much as possible. In the process of use, we should also pay attention to monitoring the changes of blood pressure level, regularly review whether there are side effects, and carry out corresponding treatment under the guidance of doctors.
Diuretics are one of the five antihypertensive drugs, and they are also commonly used counterfeit drugs when many refractory hypertension or other antihypertensive drugs are intolerable. What should I pay attention to when taking diuretics to lower blood pressure? Let's take a look together.
First, pay attention to electrolyte disorder.
The common side effect of diuretics is probably electrolyte disorder! Including hypokalemia, hypomagnesemia, hyponatremia, hypocalcemia and so on! In particular, the greater the dose, the longer the use time, the more significant the diuretic effect, and the greater the probability of its occurrence!
Second, pay attention to low blood pressure.
One of the reasons why diuretics reduce blood pressure is to reduce blood volume and heart load, which has synergistic antihypertensive effect with other drugs. Therefore, when diuretics alone are ineffective or other drugs are ineffective, our combined use with other drugs may cause excessive blood pressure drop, leading to hypotension and insufficient blood volume!
Third, pay attention to the increase of serum uric acid.
Another adverse reaction to the use of diuretics is that diuretics will increase the level of serum uric acid, so in patients with gout, it may aggravate the symptoms of gout, so we must pay attention to monitoring uric acid when using it, and adjust it in time if there is gout attack!
Fourth, pay attention to blood sugar instability.
Diabetic patients, especially when using thiazide diuretics, can increase blood sugar, decrease glucose tolerance and increase insulin resistance. Therefore, when using diuretics, the patient's blood sugar will become difficult to control.
Thiazine diuretics are widely used oral diuretics and antihypertensive drugs, which have a good effect on preventing recurrence of stroke and treating fluid retention in heart failure. As long as you follow the doctor's advice, take it according to the dose and check the level of ionized water and blood pressure regularly, there will be no adverse effects.
First, the role of thiazide diuretics
In the classification of antihypertensive drugs, there is a class of drugs called diuretics. Commonly used antihypertensive diuretics refer to thiazide diuretics, including hydrochlorothiazide, benzylthiazide, hydrofluothiazide, cyclopentthiazide and so on. There are also diuretics such as indapamide, chlorthiazone and metolazone, which are called thiazide diuretics. Although the chemical structure is different from thiazide, the diuretic mechanism is similar. Hydrochlorothiazide and indapamide are the most commonly used drugs.
Thiazine diuretics can inhibit the reabsorption of sodium ions by renal tubules, thus promoting the excretion of sodium and water. This mechanism is especially suitable for blood pressure control of patients with high salt intake in China, and it is cheap and suitable for national conditions. Moreover, diuretics are the only drugs that can completely control fluid retention in patients with heart failure, and are suitable for all patients with heart failure and fluid retention. Thiazine diuretics can also significantly reduce the risk of stroke recurrence. Thiazine diuretics can reduce the systolic blood pressure of the elderly more, so they are very suitable for elderly patients with isolated systolic hypertension, obesity, hypertension complicated with heart failure and stroke.
Second, the influence of thiazide diuretics on kidney
After thiazide diuretics are absorbed orally, the drugs are mainly excreted from renal tubules, which is suitable for hypertensive patients with normal renal function. When renal insufficiency, creatinine greater than 180umol/L or glomerular filtration rate less than 30ml/min, the effect becomes worse, and severe renal failure is prohibited.
Long-term large-scale application may cause ion disorder and increase the levels of blood urea nitrogen, blood creatinine and blood uric acid. Patients with gout should use thiazide diuretics with caution. Relatively speaking, the adverse reactions of indapamide are lower than hydrochlorothiazide, and the incidence of hyperuricemia is also lower than thiazide. Non-acute gout patients can consider using it after weighing the advantages and disadvantages.
Third, what should I pay attention to when taking thiazide diuretics?
1, Allergy: Thiazine diuretics contain sulfanilamide structure, so people who are allergic to sulfanilamide can't take them.
2. Effect on blood sugar: Long-term and large-scale use of thiazide diuretics may cause insulin resistance, increase blood sugar and weaken the efficacy of oral hypoglycemic drugs. Therefore, diabetic patients should be careful to use thiazide diuretics to lower blood pressure, monitor blood sugar and adjust the dosage of hypoglycemic agents.
3. Ion disorder: Long-term and large-scale use of thiazide diuretics will lead to the decrease of plasma potassium, sodium, magnesium and chlorine, and the increase of calcium ion level. Therefore, when using diuretics for a long time, the ion level should be monitored regularly.
4. Start with a small dose: the adverse reactions of thiazide diuretics are closely related to the dose, and the low dose (6.25~25mg) has little effect on metabolism; When it exceeds 100mg, the drug effect cannot be increased. Therefore, thiazide diuretics are recommended to be taken in small doses.
5. Potassium supplementation: Low potassium caused by thiazide diuretics may cause malignant arrhythmia and sudden death. Therefore, attention should be paid to potassium supplementation when using a single drug. Or combined with potassium-preserving diuretics (such as spironolactone, triamterene, etc.). ), potassium-increasing and antihypertensive drugs (Pulitzer or sartan).
Four. Matters needing attention in daily use
In order to avoid excessive urination at night, thiazide diuretics should be taken every morning. In order to avoid irritation to gastric mucosa, you can choose to take it after meals. This kind of medicine may cause photosensitive dermatitis, so you should pay attention to sunscreen or use sunscreen during taking the medicine. This medicine may cause postural hypotension, so be careful when you get up and go to the toilet to avoid fainting caused by postural hypotension.