Hi, Max
I have recently been researching Spironolactone, which is a diuretic that works in a very different way from many of the other diruetics. It is of an older class of drugs which many doctors fail to address in their practice of medicine, probably in favor of a "newer is better" mentality.
If you have a tendency to drop K, there is a possibility you are high in the hormone aldosterone. If your aldosterone is high, many blood pressure meds like Norvasc (I had one cardiologist who refused to believe that I did not respond to Norvasc, and said he has never seen a patient in thousands who does not--but I don't) simply won't touch it. Spironolactone is a diuretic that also works as an aldosterone blockade and is very specific to an elevation in aldosterone, which is apparently unusual in the general population. Spironolactone is usually prescribed for heart failure, but I have been doing research on it and it is known to regulate HTN and I have not found any reason it cannot be used to regulate blood pressure in the small population that is resistant to usual attempts to manage blood pressure.
If your HTN responds to spironolactone, have your doctors consider whether your hypertension might be secondary to another condition which elevates your aldosterone. There are tests (of course!) they can do for this.
If you are a man, you might try a new diuretic called eplerenone, which works like spironolactone but does not have some of the side effects that men find difficult to tolerate.
Here is some information from the CHFpatients site. This little article was contributed to the site quite a while ago. I believe this drug is well out of clinical trials by now:
"Aldosterone is the final product of the RAS :
Renin-Angiotensin-Aldosterone systemS). It is a mineral-
corticoid hormone that helps maintain electrolyte balance.
Although ACE inhibitors and ARBs suppress the RAS, they
do not completely control blood levels of aldosterone.
Spironolactone does control blood aldosterone levels but
due to its uncontrolled binding to other steroid receptors
it causes unwelcome side effects.
Eplerenone - the first of a new class of drugs
called SARAs (Selective Aldosterone Receptor Antagonists) -
is being tested.
In phase 2 trials, eplerenone controlled blood
pressure with once or twice daily dosing, and was safe and
well tolerated in CHF patients already taking standard CHF
drugs. Ongoing phase 3 trials are underway.
Title: Eplerenone: a selective aldosterone receptor antagonist
Authors: Delyani JA, Rocha R, Cook CS, Tobert DS, Levin S,
Roniker B, Workman DL, Sing Yl, Whelihan B.
E-mail: [email]john.a.delyani@pharmacia.com[/email]
Source: Cardiovasc Drug Rev 2001 Autumn;19(3):185-200
PMID: 11607037"
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