Hypertension
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
Malignant hypertension must be treated in an intensive care unit (ICU). The BP is slowly and continually reduced by using a short-acting titratable intravenous medication. Based on the involved target organ, drug choice and the method of BP reduction are varied. Usually, the goal is a 20%–25% reduction in mean arterial pressure over about 1 hour. Additional titration is used based on the patient’s symptoms. It is not necessary to achieve a normal BP quickly. First-line agents usually include fenoldopam, nitroprusside, labetalol, and nicardipine. Methyldopa, an aromatic-amino-acid decarboxylase inhibitor, is also used. Nitroglycerin used on its own is not as potent as these drugs. Oral drugs have varied onset and are difficult to titrate. Though short-acting nifedipine reduces BP quickly, it can cause potentially fatal cardiovascular and cerebrovascular events. Thiazide diuretics such as hydrochlorothiazide are also used. Cardiac glycosides include drugs such as digoxin.
Sodium Intake and Hypertension
Austin E. Doyle, Frederick A. O. Mendelsohn, Trefor O. Morgan in Pharmacological and Therapeutic Aspects of Hypertension, 2020
Diuretics are the drugs used most extensively in the treatment of hypertension, and the introduction of thiazide diuretics was perhaps the most important single advance in the therapy of hypertension. Despite their widespread and long-term use, the mechanism by which they lower blood pressure remains debated. They probably lower blood pressure by reducing the sodium content of the body, but may also have a direct vasodilator action on blood vessels. All diuretics are primarily natriuretic or chloriuretic agents which enhance the excretion of sodium or chloride, which increases water excretion. Diuretics have certain common features and certain dissimilar features. The common features relate to volume depletion and the intrarenal compensations which take place consequent to the excretion of sodium chloride and water, while the dissimilar features relate to their specific sites of action in the nephron and to their chemical structures.
Diabetic nephropathy
Moshe Hod, Lois G. Jovanovic, Gian Carlo Di Renzo, Alberto de Leiva, Oded Langer in Textbook of Diabetes and Pregnancy, 2018
Furthermore, in women with diabetic nephropathy, early-onset and intensive antihypertensive treatment most likely also reduces the severity of preeclampsia and preterm delivery.1,2,4 It is often necessary to use a combination of different antihypertensive agents to control blood pressure and urinary albumin excretion.4 Methyldopa, labetalol, nifedipine, and diltiazem are often used and are apparently safe in pregnancy.4,60,67 In addition, diuretics, both thiazides and loop diuretics, may be used with caution during pregnancy, and we often find it necessary to continue with unchanged dose of diuretics if the women are already treated with this class of drug prior to pregnancy due to diabetic nephropathy,4,60 while we normally do not use diuretics in other pregnant women. Many women with diabetic nephropathy can be controlled with one or two antihypertensive agents, but as many as four different antihypertensive classes of drugs, including diuretics, are used for selected pregnant women at our center in order to stabilize the blood pressure.2,4,60 Although antihypertensive agents have been reported to be associated with intrauterine growth restriction,68 this seems not to be the case in women with diabetes.1,2
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.
A new role for an old drug: acetazolamide in decompensated heart failure
Published in Expert Opinion on Pharmacotherapy, 2023
Sheila A Doggrell
Like acetazolamide, the thiazide diuretics have an alternative mechanism of action to the loop diuretics. The thiazide diuretics inhibit the Na+/Cl− cotransporter in the distal convoluted kidney tubule, to induce a natriuresis. However, the extra sodium in the kidney tubule can trigger K+ loss, and to prevent this, the dose of the thiazide diuretic must be limited. The thiazide metolazone has been added to furosemide in a retrospective trial of 132 subjects with acute heart failure and shown to produce a better diuretic response and improve congestion score than furosemide alone, without causing hypokalaemia [11]. Thus, the thiazides should be considered as an alternative to acetazolamide as an add-on to loop diuretics in the treatment of acute decompensated heart failure.
Telmisartan/hydrochlorothiazide-induced nevus-associated cutaneous melanoma: first report in the medical literature
Published in Expert Review of Clinical Pharmacology, 2021
Georgi Tchernev, James W Patterson
The data of another scientific team presented a year later as a poster at the American Academy of Dermatology annual meeting, 2016, Washington, DC, USA [26], are similar. For the period from 2010 to 2015, in the framework of this retrospective follow-up, the data of over 635,687 patients were reviewed, and in 5772 of them initial therapy with angiotensin receptor blockers was started. The occurrence of various forms of skin cancer and especially melanomas was monitored in this group after administration of thiazide diuretics and angiotensin receptor blockers (as monotherapy) (Fig. 2) [26]. Statistical analysis of the data showed a twofold increased risk of developing melanoma within this group of patients (OR; 2.21; 95% confidence interval (CI): 1.45–3.36), (Fig. 2) [26]. A two-fold increased risk in the same study was also observed in the group of patients taking thiazide diuretics (OR: 2.03; 95 CI: 1.04–3.92) [26].
Related Knowledge Centers
- Chlorothiazide
- Distal Convoluted Tubule
- Diuretic
- Indapamide
- Antihypertensive Drug
- Benzothiadiazine
- Thiazide-Like Diuretic
- Sodium-Chloride Symporter
- Lumen
- Methylchloroisothiazolinone