The wide range of antihypertensives in the market is likely to confuse the patient. How do they differ from one another? What is the best one for you? The following guide will hopefully give you a better understanding of these drugs and make things easier for you.
Diuretics are the earliest drugs for hypertension that have been around since 1957. Many doctors prescribe them first and over 15 million Americans use them. They lower blood pressure by increasing the rate at which sodium and water are eliminated from the body.
The main advantage of diuretics is their low price. Patients don’t’ have to spend much while using them. The bad news is that they have a lot of side effects.
“One man in three who take diuretics becomes impotent. These agents often raise blood sugar (which, however, returns to normal when you stop the drug). They elevate uric acid levels in the blood, and a high uric acid causes gout so that if you’re vulnerable, you may wake up one morning with a big red, swollen, painful toe. They can upset an empty stomach (so always have your diuretic with food or milk). And then there’s the matter of voiding. Diuretics are usually taken once a day, either with breakfast or at bedtime. A morning dose will keep you ‘running’ all day; taken at bedtime you’re likely to get up every hour or so during the night to empty your bladder,” said Dr. Isadore Rosenfeld of the New York Hospital – Memorial Sloan – Kettering Cancer Center in “The Best Treatment.”
But that’s not all. While increasing the elimination of salt and water from the body, diuretics may rob you of valuable minerals like potassium and magnesium. This can leave you weak and confused.
Low potassium levels, a condition called hypokalemia, have been linked to arrhythmias or irregular heart beats. Researchers believe this was the cause of death of some male hypertensive patients in Australia who received diuretics without potassium supplementation.
On the basis of this and other findings, Dr. Hamid Ikram, head of the Department of Cardiology at the Princess Margaret Hospital in Christchurch, New Zealand said that “diuretic therapy may shorten lifespan.”
There are other ways in which diuretics can make life miserable for you. While they can effectively lower blood pressure, they do not decrease the incidence of heart attacks. This is probably because diuretics have the nasty ability of raising the blood’s cholesterol level, making the patient susceptible to heart disease.
“Statistically speaking, when, blood pressure has been lowered by a diuretic, the incidence of heart attacks is not decreased. We used to think that as long as your blood pressure stayed down, no matter what medication was used, the risk of heart attack was reduced. That appears to be true for almost every antihypertensive drug except the diuretics. In other words, when blood pressure has been normalized by using diuretics, the incidence of stroke is decreased, but not the incidence of heart attacks,” Rosenfeld warned.
“For all these reasons, I prefer not to prescribe diuretics as first-line drugs in white hypertensive patients. However, despite their drawbacks as antihypertensives, they do have an important place in the treatment of heart failure, whenever the body retains fluids and in certain ‘sodium-sensitive’ forms of high blood pressure, especially common in blacks,” he added, (Next: Beta-blockers for hypertension.)
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