Diuretics For Hypertension

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.

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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.)

Diuretics For Hypertension

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Beta-blockers For Hypertension

Beta-blockers are drugs which block the effects of adrenaline and other hormones that stimulate the heart and cause blood pressure to rise. They have been available since the 1960s and are being prescribed for a variety of medical conditions.

"Beta-blockers, which relax the blood vessels by blocking certain nerve impulses, are very versatile drugs. These agents have some 20 different approved uses or indications. Besides lowering blood pressure, they prevent anxiety and panic attacks, a boon for entertainers and public speakers; they are a mainstay in the treatment of angina, irregular heartbeats and heart attacks," according to Dr. Isadore Rosenfeld of the New York Hospital - Memorial Sloan - Kettering Cancer Center in "The Best Treatment."

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"They control tremors; they make withdrawal from alcohol more tolerable; they're effective in preventing migraine headaches; two of them, timolol and betaxotol, are widely used to reduce elevated pressure in the eye due to glaucoma; they are used in thyroid disorders; one is even a vaginal contraceptive," Rosenfeld added.

When administered for hypertension, beta-blockers may be given alone or in combination with a thiazide diuretic. Unfortunately, their use here is limited because of side effects like fatigue, lethargy and impotence.

Beta-blockers appear to be more effective in young, white patients whose elevated blood pressure is caused by medium or high renin levels. This is a hormone made by the kidney which affects blood pressure.

But if that's not your problem, you might as well forget these drugs for they won't do you any good. Neither should they be taken if you have heart failure, asthma or heart block.

Another problem with beta-blockers is that they can decrease the blood level of good cholesterol and promote atherosclerosis, the buildup of fatty deposits in the artery walls. This increases your risk of a heart attack or stroke.

"These drugs should be avoided if you have chronic lung disease like emphysema, bronchitis, or asthma because they can induce bronchial spasm; or they can worsen matters if your heart rate is slow to begin with. They often cause impotence, fatigue, bad dreams and constipation," Rosenfeld said. (Next: Calcium-channel blockers for hypertension.)

Beta-blockers For Hypertension

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Complications of Hypertension

The symptoms of hypertension include headaches, fatigue, dizziness, ringing in the ears and frequent nosebleeds. But not all people experience these.

In fact, the majority of hypertensive persons have no obvious symptoms. One may have high blood pressure for years without noticing anything or feeling different. Because of this, the problem is usually ignored.

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Doing so, however, is your ticket to an early grave. For hypertension can extensively damage the body. Over the years, the excessive force of blood on the artery walls can lead to heart attacks, strokes, kidney failure and other serious complications.

"High blood pressure ranks as the main cause of stroke because it weakens arteries in the brain, paving the way for a rupture or blood clot. It also contributes to coronary atherosclerosis (the buildup of fatty deposits in the arteries that nourish the heart) which increases the risk of a heart attack. It damages tiny vessels in the kidney that are needed for filtering the blood, which can lead to kidney failure. High blood pressure can also cause blindness by damaging vessels that provide blood to the eye's retina," according to Larry Katzenstein, senior editor of American Health magazine.

"The fact that high blood pressure is a 'silent killer' and a major cause of death and disability was not always appreciated. Medical books published in the early 1900s didn't even list hypertension in the index. And as recently as 1950, there were doctors who believed that as long as you were feeling fine, high blood pressure didn't mean a thing. The magnitude of the problem and its impact on health is now more realistically understood," added Dr. Isadore Rosenfeld of the New York Hospital - Memorial Sloan - Kettering Cancer Center in "The Best Treatment."

What can you do about hypertension? For mild cases (in which blood pressure measures 140/90 or 140/104), lifestyle changes may be all that's necessary. This is preferable than taking drugs and is the approach used by most doctors.

"In most instances, mild hypertension can be controlled once you remove the factors that, contribute to it. Since many of these factors are controllable, modifying these through lifestyle changes will often result in an improve¬ment of a person's condition," said Dr. Desiree M. Narvaez, a medical specialist formerly with the Department of Health Non-Communicable Disease Control Service in Manila.

"Two factors account for the shift away from drugs in treating mild hypertension: uncertainty over whether their benefits outweigh their unpleasant and possibly harmful side effects, which can range from fatigue and headaches to elevated cholesterol levels; and recent evidence that nondrug approaches can often lower blood pressure to normal levels," Katzenstein added. (Next: Drugless ways to fight hypertension.)

Complications of Hypertension

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When to Treat Hypertension

When your blood pressure is over 140/90 mm Hg (millimeters of mercury), lifestyle changes might not be able to bring it back to normal levels. If after three or six months there is no improvement, you need medicines to control the condition.

"Hypertension treatment clearly prevents death and illness. Data recently compiled from many studies show that for mild and severe hypertension, combined antihypertensive drugs reduce the incidence of strokes 42 percent and heart disease 14 percent," according to Larry Katzenstein, senior editor of American Health magazine.

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In the past, taking drugs for hypertension meant choosing between the lesser of two evils. It was a difficult choice since hypertension often has no symptoms but could eventually lead to a stroke or heart attack.

While drug therapy prevented these dangers, it made patients suffer from impotence, headaches, dizziness, dry mouth, fatigue, frequent urination, and other unpleasant side effects.

Although some of these drugs remain in use today, reduced doses given by doctors nowadays have greatly lessened side effects and can effectively treat hypertension at the same time. What's more, other new medications have been developed which can control high blood pressure without making things difficult for the patient.

"In the past decade, literally hundreds of new medications that are much easier to take have become available for the management of high blood pressure. There's no longer any reason for you to fear their consequences. If you can't tolerate a particular one, there are several others on which to fall back," said Dr. Isadore Rosenfeld of the New York Hospital - Memorial Sloan -Kettering Cancer Center in "The Best Treatment."

"Patients with side effects for one drug can usually be shifted to another that won't cause problems. Most of the drugs can be taken just once a day, which adds to their convenience. The goal is a drug regimen that lowers blood pressure below 140/90 mm Hg while causing minimal side effects," Katzenstein added.

In treating hypertension with drugs, how low should you go? Doctors once thought that the lower the blood pressure, the better for the patient. They even kept readings below 120/80 - the classic "normal" blood pressure. Such low levels, however, can be just as bad as hypertension, especially in the elderly.

"A study published in the Journal of the American Medical Association suggested that patients faced an increased risk of heart attack when their diastolic pressures fell below 85 mm Hg. The authors speculate that hypertensives with preexisting heart disease may need the heart's blood flow maintained above that level," warned Katzenstein. (Next: Drugs for hypertension.)

When to Treat Hypertension

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More Drugless Ways to Control Hypertension

Here are more ways to control hypertension without the use of drugs. These guidelines were issued by the Department of Health (DOH) in Manila and are recommended for those with mild hypertension (those with a reading of 140/90) who have no underlying disease.

EXERCISE REGULARLY. Exercise leads to weight loss which, in turn, lowers your blood pressure. So if you're hypertensive and are overweight, a little exercise can solve both problems.

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If you haven't been exercising for a long time now, have a medical checkup before you embark on a fitness program. Begin gradually and work your way up to a level that's not too taxing for you.

Contrary to popular belief, you don't have to use expensive equipment or join a marathon to benefit from exercise. Neither should exercise leave you out of breath and close to a heart attack.

Walking is simple yet it is a good exercise for most people. So is swimming, jogging, or aerobic dancing. Proceed at your own pace and you'll be surprised at the results.

"You should exercise at least three times a week. That will keep you in good shape and lower your blood pressure," said Dr. Desiree M. Narvaez, a medical specialist formerly with the DOH Non-Communicable Disease Control Service.

REDUCE SALT INTAKE. People with hypertension think they're doomed to a life without salt. This is impossible since salt is found in all plants and animals and is required for the normal functioning of the body. Salt restriction - not the avoidance of salt - applies mainly to hypertensive individuals who are "sodium-sensitive" or those whose readings soar whenever they take excessive salt.

"It's not true that everyone with hypertension must follow a salt-free diet. Only certain individuals need to reduce their intake appreciably. You can determine if you're one of them by going on a strict low-salt diet for a few weeks. If your blood pressure doesn't drop much, then you are probably not salt-sensitive and can enjoy the health advantages (and pleasures) of moderate salt intake without risk," revealed Dr. Isadore Rosenfeld of the New York Hospital - Memorial Sloan-Kettering Cancer Center in "The Best Treatment."

If you happen to salt-sensitive, decrease your total salt intake to less than one teaspoon a day to reduce hyperten¬sion. The body's daily requirement is half a grain (or a quarter teaspoon), but many people consume three to four teaspoons of salt daily.

"For people trying to cut back on sodium, hiding the salt shaker won't do the job. About 70 percent of our sodium intake comes from processed foods, so it's important to read ingredient labels. Foods notoriously high in sodium include salted pretzels, sausages, pickles, tomato juice and canned vegetables," said Larry Katzenstein, senior editor of American Health magazine.

Other high-salt goodies include bacon and ham, luncheon meats, and cheese and cheese products. Hold the ketchup, mustard and soy sauce as well or your blood pressure could shoot up like a rocket.

LAST BUT NOT THE LEAST, HAVE YOUR BLOOD PRESSURE CHECKED REGULARLY. Visit your doctor regularly to have your blood pressure checked. It's also wise to invest in a sphygmomanometer and learn to take your own blood pressure at home. Various devices are available. Your physician can advice you on which model to buy. (Next: When to treat hypertension.)

More Drugless Ways to Control Hypertension

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