A writer contributes:
Diuretics for hypertension: are they something that you should consider? You see, in my experience as a senior Health Care Specialist, there are few (if any) pharmaceuticals approved specifically for use in the treatment of hypertension. What this means is that if you suffer from hypertension, you really are at the mercy of whatever the manufacturer of the drug happens to be patenting. Can you imagine the kind of devastation that could occur if your physician prescribed a heart attack drug and it worked on you, but the manufacturer had patent rights to the drug! This is why I am so opposed to the idea of diuretics for hypertension. And it is also why many of my colleagues in the health care industry, are so opposed to the use of diuretics for hypertension.
What are diuretics for hypertension? And who is affected by diuretics for hypertension? In my experience it seems that diuretics are best reserved for the management of “hypertensive” symptoms – when we refer to hypertension we are usually talking about a “syndrome”. But a syndrome can have many different manifestations. The most common manifestations of hypertension are fatigue, weakness, insomnia, and decreased mental alertness to the point where the patient may not remember things that have happened days or years ago.
Diuretics work by lessening the flow of urine. They do this by interfering with the action of various hormones in the body. The interference effect is temporary and occurs only while the diuretics are in use. The overuse of diuretics for high blood pressure will eventually lead to dehydration, which is known to be one of the complications of heart disease. The overuse of diuretics for the treatment of hypertension has been shown to be associated with an increased risk of heart failure.
What’s the story with these inhibitors? There is no medical research that I know of that mentions or discusses the possible link between diuretics use and an increased risk of heart failure. One document that mentions this possibility mentions that there are some rare cases where patients with liver disease have had cardiac arrest while on diuretic use. If there are any such cases, there are no details given regarding their cause or survival. So at this point in time there really isn’t any scientific proof either way that diuretics raise blood pressure levels beyond normal limits.
It seems that a lot of doctors feel that using diuretics for hypertension is a way too aggressive an approach. There are some rumblings within the medical profession as to how aggressive this type of treatment is and how it increases the likelihood of death. Some of this is coming from the pharmaceutical companies who sell diuretics. One physician states: “Dihydrotestosterone [DHT] is the male hormone responsible for sexual dysfunction in both men and women. The more DHT you have in your body the less energy you’ll have, and that directly influences your body’s ability to burn fat and maintain a normal blood pressure.” This physician goes on to state that there is evidence linking high blood pressure to increased levels of diuretics for hypertension.
Another doctor who works with elderly hypertensive patients states: “I think that the real question is if you’re going to prescribe diuretics for everybody. You have to ask yourself if you can control hypertension with a medication that will give you a milder form of the problem, which is actually going to help you lose weight and have some diuretic side effects.” These statements seem to indicate that there may be a negative interaction between diuretics and hypertension and therefore are not supportive of the use of diuretics for hypertension. However, these same doctors also recognize that elderly hypertensive patients often have kidney disease, which could increase their need for diuretics.
These doctors are suggesting the possibility of an undesirable interaction of diuretics and hypertension, but many other doctors have disputed these statements. For example, Dr. Peter Koffler, professor at the Department of Internal Medicine, University of Miami School of Medicine states: “The study by Fanconi and colleagues is highly debated. They say that their results demonstrate no effect, but I disagree. My data suggest a very low risk of hypertension in elderly hypertensive patients taking dosages comparable to the present therapy [diuretics] given at the recommended dose, without a diuretic.” He goes on to state that further study is needed in order to establish the safety and efficacy of diuretics for the prevention of hypertension in the elderly.
The majority of physicians agree that diuretics can be used successfully in the treatment of persons with hypertension. However, they remain controversial for the treatment of hypertension in the elderly. There are several reasons for this. One of these reasons is that the medical histories of most elderly patients are usually quite difficult to assemble and may not accurately reflect the true incidence of hypertension. Another reason is that many elderly patients are reluctant to undergo treatment and some may believe that they suffer from a disease that does not require medical attention.