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Principles of Heart Failure Pharmacotherapy
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Erika L. Hellenbart, Stephanie Dwyer Kaluzna, Robert J. DiDomenico
Several thiazide-like diuretics have been studied as part of sequential nephron blockade and their efficacy is considered a class effect; superiority of a single agent, including IV chlorothiazide, has not been demonstrated.72–74 Therefore, equipotent doses of any thiazide-like diuretic (Table 5.4) should be effective. Chlorothiazide has the shortest half-life and, along with hydrochlorothiazide, has the shortest duration of action (<24 hours; Table 5.4).75 In contrast, the half-lives of bendroflumethiazide, indapamide, and metolazone are longer and their effects can persist for 36–48 hours, particularly in patients with CKD.72,75,76
Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
A variety of thiazide diuretics may also be employed as an adjunct in the treatment of hypertension. However, they should not be initiated after 20 weeks gestation because they may interfere with the ‘normal’ pregnancy expansion of blood volume and thus placental perfusion.
Diabetes insipidus
Published in Nadia Barghouthi, Jessica Perini, Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Nephrogenic DIDDAVP is ineffective, as there is resistance to ADH at the level of the kidneys.Encourage drinking to thirst to avoid development of hypernatremia.NSAIDs and thiazide diuretics have been used in nonpregnant patients but are not recommended in pregnancy.18
Effectiveness of thiazide and thiazide-like diuretics in advanced chronic kidney disease: a systematic review and meta-analysis
Published in Renal Failure, 2023
Flávio Teles, Jorge Artur Peçanha de Miranda Coelho, Rosivânia Maria Albino, Fernanda Cristina Verçosa Pacheco, Evilly Rodrigues de Oliveira, Marcelo Augusto Duarte Silveira, Audes Diógenes M. Feitosa, Rodrigo Bezerra
Thiazides are part of the therapeutic arsenal used to treat hypertension, standing out as one of the first-line choices. However, the main hypertension guidelines do not recommend thiazides in stages 4 and 5 CKD. For example, in the 2018 ESC/ESH Guidelines for the Management of Arterial Hypertension, it is recommended that thiazides be avoided in patients with a GFR < 45 mL/min/1.73 m2, giving preference to loop diuretics [5]. It is important to at least discuss the impact of changing this recommendations based on the following reasons. Loop diuretics have a shorter half-life (6 h) than thiazides, such as chlorthalidone. Given their longer half-life (12–24 h), thiazides ensure longer-lasting BP control with a lower risk of intravascular depletion compared with loop diuretics.
The International Society of Hypertension Guidelines 2020 – a new drug treatment recommendation in the wrong direction?
Published in Blood Pressure, 2020
Sverre E. Kjeldsen, Krzysztof Narkiewicz, Michel Burnier, Suzanne Oparil
It is peculiar that in the ISH Guidelines only two outcome trials [6,7] performed in the Nordic countries, United Kingdom and the United States, provided the evidence base for the most important recommendation, choice of first line treatment, for hypertensive patients throughout the world. Numerous outcome trials in hypertension have shown the benefit of thiazide or thiazide-type diuretics in preventing cardiovascular disease outcomes. All placebo controlled trials of antihypertensive medications have shown that active treatment prevented cardiovascular disease outcomes, including stroke, heart failure, myocardial infarction, left ventricular hypertrophy and aortic aneurysm. Outcome trials that have compared diuretics with beta-blockers have shown no differences for the primary endpoints.
Drug treatment strategies for osteoporosis in stroke patients
Published in Expert Opinion on Pharmacotherapy, 2020
Cheng-Yang Hsieh, Sheng-Feng Sung, Huei-Kai Huang
Hypertension is a major risk factor for stroke, with about 70% of stroke patients having hypertension [82]. Thiazide diuretics have been commonly used to treat hypertension for decades. In addition to the benefit of blood pressure lowering, thiazide diuretics have been found to preserve BMD and prevent hip fracture. The potential mechanisms include reduced urinary calcium excretion through potentiating renal action of PTH [89], increased intestinal calcium absorption [90], stimulation of osteoblast differentiation [91], and metabolic alkalosis that leads to decreased bone resorption [92]. A Cochrane systematic review and meta-analysis [93] showed that thiazides were associated with a reduction of hip fracture risk (pooled RR, 0.76; 95% CI, 0.64–0.89) in adults older than 40 years. In a recent population-based and propensity score-matched cohort study focusing on subjects with acute ischemic stroke [94], the use of thiazides after stroke was associated with a lower risk of hip fracture (adjust HR, 0.64; 95% CI, 0.46–0.89). In the sensitivity analysis, the risk of hip fracture decreased as the duration of thiazide use increased. Thiazide use for more than 50% of the time over a period of 2 years was associated with a decreased risk of hip fracture (adjusted HR, 0.41; 95% CI, 0.22–0.79), as compared to no thiazide use.