Many doctors prescribe various diuretics to patients with hypertension. Patients who come to see Dr. Shishonin at the clinic are often interested in whether diuretics can be used for hypertension, how they work and what effect they have on the body. Alexander Yuryevich Shishonin, cardiologist, therapist, cardiac surgeon, candidate of medical sciences and creator of many methods for restoring muscles, joints and blood vessels, talks in detail about diuretics for hypertension.
Classification of blood pressure drugs
- ACE (angiotensin-converting enzyme inhibitors). Prevents the production of angiotensin (a substance with a vasoconstrictor effect). Dilate arteries, lowering blood pressure.
- ARBs (angiotensin II receptor blockers). They inhibit those receptors to which angiotensin binds, dilating blood vessels and lowering blood pressure.
- Calcium antagonists/calcium channel blockers. They prevent the penetration of calcium ions into the cells of blood vessels and myocardium (heart muscle), preventing contraction mechanisms. The arteries relax, which leads to an increase in their diameter and a decrease in blood pressure.
- Diuretics (diuretics). They normalize blood pressure by removing excess fluids and salts from the body. Loop diuretics are prescribed primarily in hospital settings.
- Beta adenoblockers affect the production of hormones that increase heart rate. They normalize heart rate by influencing the sympathetic nervous system and blood pressure levels.
Blood Pressure Tablets: Part I
High blood pressure is one of the most common health problems in Russia. This disease is especially common in older people who have to “take pills” to feel good and relieve stress on the heart. What is blood pressure, why does it rise too much, how diuretic medications help normalize it and how to take them correctly - read about all this in our article.
What is blood pressure
When the heart muscle contracts, it forcefully pushes out a large volume of blood, putting pressure on the walls of the blood vessels. Depending on the location, this pressure is called arterial (BP), venous and capillary. Pushing a fluid as thick as blood through 100 billion capillaries is no easy task. Due to the natural resistance of this complex network of microscopic vessels, the blood pressure “at the entrance” to the heart is much lower than “at the exit” from it.
The blood pressure “at the exit” of blood from the heart (that is, at the moment of its contraction) is called systolic, and the blood pressure “at the entrance” to the heart at the moment of its relaxation is called diastolic.
The average norm for an adult is considered to be 120/80 mm. rt. Art.; The first number in this case means systolic blood pressure, and the second number means diastolic. Thus, normally, the resistance of the capillary network “eats” 34% of the initial “power” of the blood flow.
In practice, the ratio of the two blood pressure readings varies greatly among different people and even within the same person at different points in time. It depends on a number of factors: heart rate, condition of blood vessels, elasticity of their walls (this parameter is skillfully regulated by the brain), etc.
Why is blood pressure rising?
Arterial hypertension (AH), also known as hypertension, is one of the most common diseases in the world. According to the latest WHO data, about 1.13 billion people worldwide suffer from high blood pressure. Blood pressure readings of 140/90 mm are considered elevated. rt. Art. and higher at rest.
The most common symptoms of a hypertensive crisis (a sharp increase in blood pressure in patients with hypertension) are headache, shortness of breath, chest pain and fatigue. Some patients experience dizziness, hear ringing in the ears, or notice redness on the face and chest.
The main cause of hypertension is excessive activity of the renin-angiotensin system (RAS). It is a cascade of chemical reactions that occur in the body in response to a decrease in blood pressure: the enzyme renin contained in the kidneys is converted into the enzyme angiotensin I, and then into angiotensin II. The latter is a powerful vasoconstrictor. The narrower the vessels, the higher the pressure. Angiotensin II also reduces the excretion of sodium and water by the kidneys. The more water in the tissues of the vessels, the smaller their diameter, which means the higher the pressure.
Arterial hypertension is also associated with an excess of calcium in the cells of blood vessels, as well as with an increased concentration of sodium in the vessels and in the blood. Many people know that calcium is good for bones and teeth, but not everyone realizes how important it is for the body as a whole. In fact, calcium is necessary for the transmission of nerve impulses, muscle contraction, blood clotting, the immune response, and so on. Without this metal we would not be able to think, move, or even live.
But in the body, as in life, everything is good in moderation. Calcium overload in vascular cells leads to hypertrophy of their muscle tissue. And this, in turn, means a thickening of the vessel wall and a decrease in its lumen. The “tube” becomes narrower, and, as a result, the pressure on its walls increases.
Why does calcium overload occur? Calcium metabolism in the body is regulated by hormones, and their level, in turn, depends on the concentration of other important substances. Thus, risk factors for hypertension are: obesity, sedentary lifestyle and hyperlipidemia (fat concentration), diabetes, smoking and alcoholism. In addition, old age is a key risk factor.
In the case of sodium, the risk factor is the abuse of salty foods and hormonal disorders that slow down the removal of this element from tissues. Sodium can accumulate in the blood, increasing its volume by binding water molecules. The more blood passes through the vessels per unit time, the greater the pressure on the walls of the vessels. In addition, the accumulation of sodium in the endothelium (a thin layer of cells lining the inside of blood vessels) leads to its swelling (essentially, edema) and, as a consequence, to a narrowing of the lumen of the vessel.
How do diuretics work?
In this article, we will look at only one class of drugs that are used to treat hypertension - diuretics. These medications are designed to “correct the situation” with sodium, while calcium metabolism and the functioning of the RAS are corrected by other drugs, which we will talk about in the following materials.
Diuretics improve the excretion of urine from the body, and along with it, water. Excess sodium and water leave the blood, its volume decreases and blood pressure decreases.
Diuretics act on the nephron, a structural unit of the kidney that performs filtration, reabsorption (reabsorption) and secretion of various substances. They reduce the return of previously “filtered” sodium and potassium ions into the blood. The lower the sodium reabsorption, the lower the water reabsorption. Instead of entering the blood, the water leaves in the urine.
Three types of diuretics are used to treat arterial hypertension: loop, thiazide and potassium-sparing. Loop diuretics are so called because they act on a special part of the nephron - the loop of Henle. Potassium-sparing ones differ from others in their ability to influence only sodium ions. And all thiazide diuretics are derivatives of the substance benzothiadiazine.
The latter are also capable of acting directly on the walls of blood vessels. They reduce the concentration of sodium ions in the endothelium, which reduces its swelling.
Examples of loop diuretics are torasemide and furosemide. Thiazide diuretics include indapamide. Potassium-sparing diuretics include spironolactone and triamterene.
How to take diuretics?
When taking a number of diuretics, especially loop diuretics as the most “powerful” ones, you should remember the risk of hypokalemia (potassium deficiency). It leads to serious problems with various muscle tissues - myalgia, paralysis, breathing problems and intestinal obstruction.
This is a relatively rare condition because potassium is a very common element in food. However, such risks can be caused by a combination of the action of diuretics, which “expel” potassium into the urine and, say, the consequences of prolonged diarrhea or laxative abuse. Also, medications called beta-agonists (salbutamol, fenoterol, etc.) can affect potassium concentration.
In this regard, we recommend that you begin treatment with diuretics only under the supervision of a doctor who will not prescribe incompatible drugs. Obviously, this problem does not apply to potassium-sparing diuretics.
Diuretics do not have strict guidelines for when to take oral forms, however, as is the case with many other drugs, it is better to take them before meals or a couple of hours after. Any medicine is unlikely to benefit from unnecessary interactions with food.
We wish you health, eternal 120/80 and a rational approach to treatment, including professional help from doctors!
Mark Volkov, editor of the online magazine for pharmacists and medical workers “Katren-Style”
Photo depositphotos.com The author’s opinion may not coincide with the opinion of the editors
Side effects of blood pressure pills
Any medicinal substance, no matter how high-quality and expensive it is, can lead to side effects. Some unwanted effects, such as various allergies, cannot be prevented.
Children, the elderly, pregnant women, and patients with liver and kidney damage are at risk for developing side effects.
Side effects from different groups of drugs:
- Diuretics - dehydration, water-electrolyte imbalance, decreased blood pressure, arrhythmias, photosensitivity, allergies.
- Beta adenoblockers - bradycardia, vertigo, migraines, increased circulatory failure, decreased blood pressure, nausea, bronchospasm, heart block, sleep disorders, depression.
- Calcium antagonists - bradycardia, AV block, decreased blood pressure, angina pectoris, dizziness, hot flashes, tinnitus, runny nose, abdominal pain, nausea, edema, constipation.
- ACE inhibitor - dizziness, hypotension, weakness, tachycardia, dry cough, shortness of breath, nausea, diarrhea, abdominal pain, rashes, angioedema, itching, asthenia, blurred vision, electrolyte imbalance, loss of appetite.
Why are diuretics harmful to health in hypertension?
Despite these positive properties of diuretics, diuretics for hypertension are not only useless, but can even be harmful. Increased work of the kidneys causes dehydration, and many beneficial substances are additionally washed out of the body. Why is dehydration dangerous?
- Lack of moisture causes blood to thicken, which slows down its movement through the arteries;
- Slowing blood flow inhibits the work of the heart muscle, which leads to hypotension;
- Dehydrated blood can form clots that develop into blood clots;
- Deficiency of salt, chlorine, sodium and potassium disrupts natural metabolism;
- Lack of fluid causes water-electrolyte imbalance;
- In severe cases, cardiac, renal, and respiratory failure develops.
A few decades ago, diuretics were actively used in cardiology for hypertension. In fact, they have an effect, but it is temporary. Diuretics temporarily inhibit the development of hypertension, which only delays the patient’s trip to the doctor. Excessive use of diuretics for hypertension threatens not only dehydration.
What complications does the use of diuretics lead to:
- Acid-base imbalance;
- Excess uric acid;
- Deficiency of phosphates, potassium, zinc, fluorine, chlorine;
- Lack of calcium;
- Lipid-protein disorders;
- Hypercholesterolemia;
- Hormonal imbalances;
- Oxygen starvation of the brain;
- Decirculation of blood.
Modern cardiology clinics have long abandoned the use of diuretics for hypertension. Dr. Shishonin also does not approve of their use for high blood pressure. But it makes a discount on treatment and prevention with diuretics based on herbs and natural ingredients.
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New drugs are the safest
New generation medications for hypertension cause fewer side effects and are the safest.
Advantages:
- The composition includes active ingredients that reduce the negative effects on the body. At the same time, they do not lose their effectiveness.
- The effect of one tablet is enough for at least a day, because new generation drugs have a cumulative effect.
- The medications contain substances that have a positive effect on all organs and vital systems.
What are the types of diuretics?
All diuretic drugs are divided into types according to their chemical composition, degree of tolerance by the body, strength of effect on the kidneys, positive and side qualities. There are several types of diuretics:
- Thiazide - have an average level of strength, do not require frequent use, and have a gentle effect on the cardiovascular system;
- Potassium-sparing - usually taken in combination with other diuretic drugs, as they help maintain potassium levels;
- Loop - have the ability to quickly remove fluid, while still diluting the blood flow, leaving the pressure high;
- Osmotic - intensively suck out salt and water, but increase the content of sodium and chlorine, and also provoke pressure surges.
What herbs should be used for hypertension instead of diuretics
Natural plants that have a diuretic and sedative effect are more likely to help with hypertension than drug diuretics. The main rules for taking herbs are moderate dosage, taken in the morning and mandatory consultation with a doctor. What herbs can you drink to remove excess fluid:
- Rowan - red fruits normalize blood circulation, strengthen muscles and joints, burn fat;
- Dill - calms the nervous system, stimulates the liver and kidneys, improves sleep, supplies the blood with microelements;
- Thyme - promotes normal circulation in blood vessels, has a positive effect on internal metabolism;
- Motherwort - provokes the removal of water from the kidneys, calms rapid heartbeat, eliminates vascular spasms;
- Birch - leaves and juice regulate sugar levels, break down kidney and bladder stones, block joint pain;
- Barberry - cleanses the liver of toxins, relieves atherosclerotic plaques and cholesterol, dilates artery walls.
It should be remembered that any herbal diuretics for hypertension wash out potassium, so Dr. Shishonin recommends adding potassium-containing foods to the diet.
