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Old 03-11-2005, 09:25 AM   #1
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Diuretics get a bad rap on this board, IMO ...

I just found this board- I have HBP and take a diuretic and ACE inhibitor with almost no side effects and good BP results. I was surprised to see several people here talking negatively about about diuretics- saying they dramatically raise blood lipids (cholestorol) or glucose. In reality, the landmark ALLHAT study by the National Institutes of Health found as follows:

Reality for cholesterol
When patients receive a thiazide diuretic, the average increase in cholesterol has been reported to be less than 0.3 mmol/L and these changes appear to diminish after 6 to 12 months. (30) In the ALLHAT trial, mean cholesterol levels at 4 years were statistically higher in the thiazide diuretic group than the other treatment groups, but the mean difference was only 0.025-0.05 mmol/L (1-2 mg/dL). (1)

Reality for glucose
In the ALLHAT trial, fasting glucose at 4 years was statistically different between the lisinopril and the chlorthalidone group, but again the difference was small 0.2 mmole/L (5 mg/dL). (1) Overall, 4 % more patients in the chlorthalidone group had a fasting glucose greater than 6.2 mmole/L (126 mg/dL) at 4 years. Similar changes were seen in both the diabetic and non-diabetic patients.

[url]http://www.informedpharmacotherapy.com/Issue12/Editorial/editorial12.htm[/url]

I'm sure there are always individuals who have extreme reactions, but the study showed very slight or moderate rises in lipids and glucose from taking 25 mg chlorthalidone, and chlorthalidone is a more powerful and longer-acting thiazide diuretic than the HCTZ taken by most Americans. And here's the bottom line on diuretics, IMO: the ALLHAT study clearly showed that it increased life expectancy of hypertensives who took it. Other studies have shown this as well. There's no "money" in diuretics for pharmaceutical companies since all the drugs are available generically and for little money. So if the health establishment clearly states that such drugs are beneficial, I listen to them. I think others here should consider doing so as well.

Last edited by rigel434; 03-11-2005 at 09:26 AM.

 
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Old 03-11-2005, 09:41 AM   #2
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Re: Diuretics get a bad rap on this board, IMO ...

Not quite, rigel,

I am VERY fond of diuretics and I feel they really are the ONLY class that works well for "salt sensitives." And I babble a LOT about them in this forum.

I've taken them, on and off, for nearly 3 decades and NEVER see a fasting blood glucose above 95.

And I love the fact that they are cheap, but whould you believe I have to FIGHT my new doctor every step of the way to get a new prescription...
Note to self: Get a NEW DOCTOR!

I believe they have their downside like almost all drugs , but for certain types of hypertensives, they are the sine qua non. But then NOTHING beats NO DRUGS!

 
Old 03-11-2005, 09:54 AM   #3
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Re: Diuretics get a bad rap on this board, IMO ...

"And I love the fact that they are cheap, but whould you believe I have to FIGHT my new doctor every step of the way to get a new prescription."

I had the same problem so I just order mine from an internet pharmacy in England and they arrive here in 10 days or so. Mind you, I was originally prescribed them and waited until my blood tests came back ok but at some point I realized that the doctor was just dangling the meds above me to make me come back and give him money. So I check my bp at home and order them from overseas. Does away with all that stressing about white-coat effects on hypertension as well.

 
Old 03-11-2005, 11:15 AM   #4
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Re: Diuretics get a bad rap on this board, IMO ...

Quote:
Originally Posted by rigel434
And here's the bottom line on diuretics, IMO: the ALLHAT study clearly showed that it increased life expectancy of hypertensives who took it.
Yep, that's true a 4.9 year study. But, I plan on living a lot longer than that. The fact is that the diuretic group had an 18% increased risk of new-onset diabetes when compared to amlodopine and a 43% increased risk when compared to lisinopril. This probably isn't significant for such a short term study; the additional CV risk from the new onset of diabetes isn't going to show up in this short of a term.

Also, an ACE+diuretic is a very good combo. The ACE will help protect you against the increase in risk from a diuretic. Interestingly, the ALLHAT participants were denied such combinations.

Pal

 
Old 03-11-2005, 11:22 AM   #5
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Re: Diuretics get a bad rap on this board, IMO ...

"Yep, that's true a 4.9 year study. But, I plan on living a lot longer than that."

Not to be argumentative, but in the 4.9 years the study covered, there were reduced cardiac events which would have KILLED people if the people hadn't been taking diuretics. So you'd have to assume that there's some risk from diuretics long-term which would outweigh the proven mid-term (5 yrs) benefits. That's not a risk I'm willing to take, especially since I'm nowhere close to getting diabetes based on my blood glucose. Maybe the calculus is different if your glucose is higher. But I'm not sure- the study authors recommended diuretics even for those who already have diabetes.

 
Old 03-11-2005, 02:17 PM   #6
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Re: Diuretics get a bad rap on this board, IMO ...

I'm happy that diuretics work for you without side effects. That doesn't happen for everyone. I took Hyzaar (Losartan potassium-hydrochlorothiazide) for about 2 days. I'd tried Losartan by itself, which did nothing for my hypertension, nor gave me side effects. Hyzaar gave me severe nausea, profuse sweating and finally sent me to the emergency room in the middle of the night with racing heart rate and fluctuating blood pressure. Diuretics are not for me. And with the increased risk for diabetes and high cholesterol, I plan to stay far far away from them. If I give diuretics a bad rap, it is based on personal unpleasant experience. Your milage may vary though.

 
Old 03-11-2005, 03:37 PM   #7
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Re: Diuretics get a bad rap on this board, IMO ...

Had I been on amlodipine for the same time I was on HCTZ , I have little DOUBT the Norvasc would have killed me long ago.
How I survived a month never ceases to amaze me.
It was perhaps the worst drug I ever took.
Next worse was Plavix where my nose ran with blood for a month!

But back to the original topic, HCTZ gets a fair hearing here, Rigel.

Last edited by Lenin; 03-11-2005 at 03:38 PM.

 
Old 03-12-2005, 05:56 AM   #8
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Re: Diuretics get a bad rap on this board, IMO ...

here is something that a lot of people may not realize,( may also be a little off topic as well), but also may be why some get bad side effects from hctz: if you are allergic to sulfa you may not be able to take hctz either. It is in the prescribing info. LIke I said, it has nothing to do with any studies about diabetes or anything, but I am allergic to sulfa and had to discuss this with my dr., but i am able to take hctz with no problems

 
Old 03-12-2005, 06:18 AM   #9
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Re: Diuretics get a bad rap on this board, IMO ...

Quote:
Originally Posted by rigel434
Not to be argumentative, but in the 4.9 years the study covered, there were reduced cardiac events which would have KILLED people if the people hadn't been taking diuretics.
But, that's assuming that these people weren't taking something else. Diuretics are a very useful tool. Obviously, the BP lowering effects are more important than the increased diabetes risk. However, you can get the BP lowering effects with other classes without the diabetes risk. Now, if a diuretic is the only thing that works, then go for it. It's beneficial. I just don't agree that it should be the first choice. And, it is a great mix to go with an ACE inhibitor or ARB. In fact, this combination was known back in the 1970's. See: [url]http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=372606[/url]

And, then, if you are on an ACE or ARB, do you really need a diuretic? You can get the same BP lowering effect by controlling sodium. See: [url]http://hyper.ahajournals.org/cgi/content/full/25/5/1042[/url] .

BTW, you're not being argumentative, you're expressing your opinion. That's what these boards are for.
Quote:
Originally Posted by rigel434
So you'd have to assume that there's some risk from diuretics long-term which would outweigh the proven mid-term (5 yrs) benefits. That's not a risk I'm willing to take, especially since I'm nowhere close to getting diabetes based on my blood glucose. Maybe the calculus is different if your glucose is higher. But I'm not sure- the study authors recommended diuretics even for those who already have diabetes.
I'm not sure that it's really been established exactly what it is about a diuretic that causes an increased risk for diabetes. It's certainly seems logical that an increase in blood glucose could be the cause. But, the data simply says that it increases the risk.

Here's a little 20 minute program you can watch on this subject:

[url]http://www.conversations.acc.org/modules/conv/acc/1204a/main.asp[/url]

Pal

Last edited by Palamedes; 03-12-2005 at 06:22 AM.

 
Old 03-12-2005, 08:49 AM   #10
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Re: Diuretics get a bad rap on this board, IMO ...

On diuretics: I take one as part of a combo drug. But I'm thinking about stopping. The evidence is clear: It's not risk-free. The same result could be obtained by not eating salt (too hard or strange for me). Maybe the same result could be obtained by taking Taurine or some other "natural," non-prescription diuretic. Maybe the same result could be obtained simply by drinking lots of water. Or even a decent amount of caffeine, which certainly is a natual diuretic for me (sad to say, it's strange for me not to do this!). Thoughts? All the Dr. Atkins-type low carb experts are against diuretics because they interfere with wait loss and rob you of nutrients.

 
Old 03-13-2005, 11:24 AM   #11
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Re: Diuretics get a bad rap on this board, IMO ...

Welcome Rigel,

You are correct and there are many other drugs that get a bad rap on this board. One must remember that individuals react to drugs in different ways. Some get side effects and some do not. A person's bad experience with a drug should not frighten another individual into refusing to take it. It could turn out to be the very drug that helps that person the most. I take four drugs to finally keep my BP under control. I have read horrow stories about every one of them but they do work for me. As long as a side effect is not in the danger column, I have learned to suck it up.

 
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