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Thiazide diuretics are considered to be the front-line treatment for high blood pressure (hypertension). A recently concluded large-scale study recommended they be used before other blood-pressure-lowering medications. The study, known as the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial or ALLHAT, involved more than 42,000 people aged 55 and older across the United States, Canada, Puerto Rico and the U.S. Virgin Islands.
The ALLHAT study’s conclusion was based on the finding that most blood pressure medications were about equally effective (lowering blood pressure to normal levels in 30 to 50 percent of patients). Therefore, the decision on which medication to use is based on other factors, such as the drug’s potential for side effects and its cost. Diuretics are generally well tolerated and not very expensive. Another finding of the study was that, overall, most individuals need more than one drug to treat high blood pressure, and one of those drugs should be a diuretic.
The study has, however, generated great controversy within the medical community, partly because of the finding that patients in the diuretic group are more likely to develop diabetes. The long-term consequences of this were not addressed in the study.
In addition to high blood pressure, diuretics are used to treat the following conditions:
- Heart failure. By flushing excess fluids from the body, diuretics can relieve the edema (swelling from excess fluids) that commonly occurs with heart failure. Specifically, spironolactone and eplerenone have been independently shown to benefit patients with heart failure, thus reducing the workload on the heart. Most patients with heart failure are treated with a loop diuretic, in addition to a low sodium diet. In addition, spironolactone or eplerenone may be added to increase the drug's effectiveness and reduce the loss of potassium often caused by diuretics. It is important for any patients taking diuretics for heart failure to have their electrolyte levels carefully monitored. Heart failure patients who are prescribed diuretics will often be on the medications for the rest of the lives.
- Renal insufficiency. A condition in which the kidneys are unable to function normally. Diuretics can sometimes worsen this condition.
- Hepatic cirrhosis. Destruction and scarring of liver tissues, when complicated by ascites (fluid build-up in the liver caused liver cirrhosis, heart failure or nephrotic syndrome).
- Hypercalcemia. Too much calcium in the blood.
- Diabetes insipidus (thiazide diuretics only). A pituitary gland disorder marked by excessive thirst and the excretion of large amounts of urine. Thiazide diuretics actually decrease urine volume in these patients.
- Glaucoma (osmotic diuretics only). An eye disease in which increased pressure within the eye causes damage and gradual loss of sight.
- Cerebral edema (osmotic diuretics only). A potentially fatal swelling in the brain that can be caused by hemorrhage, trauma, disease or surgery.
- Drug intoxication (osmotic diuretics only). Osmotic diuretics increase the urinary excretion of toxins introduced into the body through the use of many legal and illegal substances.
- Hyperaldosteronism (potassium-sparing diuretics only). A condition in which the increased production of the hormone aldosterone causes increased blood pressure, excessive potassium loss and muscle weakness.
- Polycystic ovarian syndrome (PCOS). A disorder marked by irregular menstruation, obesity, increased hair growth, cystic ovaries and infertility.
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