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Tamsin 09-14-2008 07:01 AM

Alternatives to HCTZ? (Long)
I am what my cardiologist refers to as "renin-sensitive" which means basically that I retain water. No matter what type of BP drug I tried in the past, HCTZ seemed to be the only component that would lower the pressure. In addition, the side effects of anything other than ARB class was the only one that didn't leave me feeling like a zombie. For awhile I was getting good control on Benicar/HCTZ.

Two years ago I landed in the ER with a dangerously low potassium level and an irregular heartbeat, tried to skip HCTZ all together but the BP surged, so my cardio decreased the HCTZ by half, and added potassium supplementation: 30-40 meqs a day, which is a lot. No matter how much supplement I took at times I would feel symptomatic if I work-outed a lot and find that my level was borderline low. For two years I've tinkered with this stuff. Yesterday was unexpectedly hot and humid and I landed in the ER for the second time with bottomed-out potassium (not as low as before but still low) and an irregular heartbeat. It's pretty much determined that I simply can't tolerate HCTZ.

On Tuesday I see the cardio and I suppose we'll do the med-dance again. I wonder if anyone has experienced this and if they found a solution? I'm really dreading going through this process again. :(

Thanks in advance.

flowergirl2day 09-14-2008 06:27 PM

Re: Alternatives to HCTZ? (Long)

I am sure you have tried a number of drugs and their combinations. No matter what the components of your antihypertensive therapy, there are bound to be some side effects. Does the water retention result in an edema, and are both the edema and your blood pressure well controlled with your current drug therapy?

Unfortunately, diuretics, besides decreasing the blood volume and blood pressure, also cause potassium depletion. Many people don't know that hypokalemia-low potassium- contributes to high blood presssure. Diuretic use (thiazide and loop) is the most common reason of low potassium levels. It is also a very common one. A part of the potassium loss is from activation of the renin-angiotensin-aldosterone system due to reduced blood volume and pressure in the arteries.

A potassium supplementation is the preferred treatment of hypokalemia. Oral potassium replacement in the recommended amounts should be safe for people with normal kidney function. The oral potassium supplementation can be combined with an increased dietary intake of potassium, and a reduced dietary sodium consumption. The decreased intake of dietary sodium will have no effect in people who are salt resistant. Treatment of an [U]ongoing[/U] potassium depletion from diuretics requires 40-120 mEq of supplemental potassium daily. Your K supplement dose is fine. :)

One option would be to remain on Hctz (especially if it works well in controlling your blood pressure), and add a potassium-sparing diuretic. A combination of two diuretics is more effective than either one alone. This is because in such a combination there are two different sites of action. The K-sparing diuretics, such as Amioloride, Eplerenone, Spironolactone and Triamterene are relatively mild diuretics. For this reason, they can be combined with another diuretic, such as Hctz or Lasix to prevent hypokalemia. I have heard that the newest one, Eplerenone, does not have the side effects some of the others do. I have been on Spironolactone and Hctz for a year and a half. My potassium level tends to be very low at times and variable. It is normal right now. This combination of diuretics seems to have worked for me in reducing my blood pressure and preventing hypokalemia. Unfortunately, it does not do much for preventing or controlling the edema. This could be partly because my dose of Spironolactone is low, due to a reduced kidney function. I also take an ACE inhibitor, another potassium-building drug. Like the potassium-sparing diuretic, it helps the kidneys conserve potassium. I can't take any potassium supplements.

Your cardiologist will select your medication based on the underlying heart condition. I wonder which drugs you've tried to date? Prior to starting the K supplements, did you have your magnesium level tested? Low potassium levels cannot be corrected, unless the magnesium level is adequate.

Another option would be trying some of the meds you had tried previously, combined with one of the K-sparing diuretics. Sometimes there are fewer side effects when a medication is taken a second time around. I read that one should never be discouraged by the side effects and give a medication another try. An ACE inhibitor and a small dose of Hctz (12.5mg) might work fine without your potassium level altered - thanks to the ACE (which is potassium-building) and the low dose of diuretic (minimal potassium loss).

Your doctor might have other ideas. Please let us know how your visit goes and what his suggestions are. Good luck!


Tamsin 09-15-2008 04:56 AM

Re: Alternatives to HCTZ? (Long)
Thank you very much for your reply.

It will be interesting to see what kind of cocktail my doctor comes up with. And despite all that's happened, I really do want to be able to keep some diuretic in my system (I'm currently on 12.5.). I didn't know it was safe to take that much K supplementation. And that is encouraging news about the K-sparing drugs, even though I have tried Triameterne and it left me dizzy drunk-like; literally slurring my words. I'm game to try another.

I will keep you posted as events unfold. Hopefully this might help another poster9s) on the board.

Thanks again. :)

bethsheba 09-15-2008 11:48 AM

Re: Alternatives to HCTZ? (Long)
[QUOTE=Tamsin;3727810]..... No matter how much supplement I took at times I would feel symptomatic if I work-outed a lot and find that my level was borderline low. ...... It's pretty much determined that I simply can't tolerate HCTZ..[/QUOTE]


Although hctz can depelte one's potassium levels, it can also deplete one's magnesium levels, and a certain ratio of magnesium is needed to "process" calcium and even if you are taking potassium supplements, your body may not be able to absorb those supplements because (most likely) you are deficient in magnesium. Please note that mag deficiencies usually don't show up in routine blood work (less than 50 percent do) so you can't rely on your lab work to id this kind of problem.....but I would certainly recommend you investigate this fully because in my opinion it is quite likely to have occurred if you have been on hctz for any length of time.

There are other reasons for potassium levels to be low so you would be wise to look into those as well...

I was low on potassium when I was first prescribed hctz and I have reason to believe that those low potassium levels played a major role in my hypertension....meds only made my numbers worse. It wasn't until I got a cpap (for sleep apnea) and used the DASH meal plan that my pressures came down to normal/below normal (I am currently med free).

I should note that although I'm not a supplement kind of person, I did resort to the use of supplements when I was on may be supplements prevented my condition from getting worse, however, they did not help me get better! I have since learned of the importance of a proper ratio of calcium to magnesium to potassium.

Good luck and let us know how you do!


Tamsin 09-15-2008 12:35 PM

Re: Alternatives to HCTZ? (Long)

Yes, I was low in Magnesium as well. Supplementing both right now. Of course without the HCTZ, I have to be careful not to take too much. But that's only for one day...It's all so tiring....

Anyway, I hope the cardiologist is in top-form tomorrow.

Thanks and I'll keep you posted!

bethsheba 09-15-2008 05:10 PM

Re: Alternatives to HCTZ? (Long)

A healthy body excretes any magnesium it doesn't use daily so very few people risk getting too much magnesium...but of course, that's not the case with potassium. I have read that it can take several months to several years to restore magnesium levels if severely deficient.


famnd 09-15-2008 10:07 PM

Re: Alternatives to HCTZ? (Long)
Hi Tamsin,

I take HCTZ (25mg) daily. After reading the package insert plus other stuff, I zeroed in on getting an adequate potassium intake daily. Eating a vegetarian diet makes it easier than following a tradtional diet.

It was not until I got my first cold/flu that I had trouble with potassium. I just didn't feel like eating or drinking much. Wrong idea when one is on a diuretic. Although I didn't go to the ER, I know my potassium was low because my b/p dropped & I got nausated (rare for me), & a few other symptoms. That's when I decided I had to have a "sick day" diet to keep my potassium levels up. For me that is fat free milk, orange juice if tolerated, cheese, can't think of the rest of the foods but I have everything written on a card. I start off with drinking a cup of orange jiuce.

I wrote a list of all my usual foods & then the amount of potassium each has. I made sure that a typical days diet has the correct amount of potassium. Real food is better than supplements because one get other compatible nutrients along with he potassium. One's Dr. is the best person to decide whether potassium supplementation is required by ordering a blood test.

I wouldn't give up on HCTZ because it does lower b/p for some of us when nothing else will. What is your dose of HCTZ. Most Dr's now know that 12.5mg is all that is needed for most patients. I know the feeling of bouncing around from one med to another & back to some of the same ones. It really disrupts one's life. It has taken me 5 yrs to get to where I am having some parts of my old life back. Fam

Tamsin 09-16-2008 09:24 AM

Re: Alternatives to HCTZ? (Long)
You two are so smart!!

Saw cardio this AM. New game plan: Keep the current meds, add low dose Spironolactone. Lower the K supplement to 40 meq. Wait and watch. If that doesn't do it, he wants to add a small dose of Norvasc (yuck). But hopefully this will work.

Last night, after dinner my BP rose to 200/120! I took a HCTZ. I figured I would have better odds surviving being hypo for a bit then a stroke. BP went down to 180 then 160 over 110. It was a scary night. When I told the cardio he raised his eyebrows but smiled and said not to worry too much. I'll be followed weekly until all is well. Doc said I need, need, need, some kind of HCTZ in my regiment.

So, I'm so relieved. Your support really made a difference. I've been a wreck for the last couple of days. We all know that's not good for the BP!! ;)

Thanks again and have a great day!

bethsheba 09-16-2008 03:49 PM

Re: Alternatives to HCTZ? (Long)
[QUOTE=Tamsin;3730105]... Doc said I need, need, need, some kind of HCTZ in my regiment....[/QUOTE]

I wouldn't be so sure about that...I was taking 50 mg of hctz, but like you it depleted my electrolytes and my pressures just went up over the 18 months I was on it...again, a healthy balance of electrolytes are needed to regulate blood pressure...thus the emphasis on sufficient potassium and magnesium levels. If you're magnesium deficient, you will not be able to process and to use the minerals needed to regulate your blood pressure. This is an excellent example of a medication making blood pressure worse.

An alternative?? Change your eating habits and abide by the DASH meal plan (simply eliminating salt from your diet is not enough). It is designed with the necessary balance of nutrients and you'll see results in a few days to 2 weeks. But again, given your mag deficiency (which I suspect is severe simply because it was identified) your results may not be as dramatic until you restock your mg stores. 99 percent of mag is stored in the bones and organs of the body...only 1 percent is in the blood and that one percent is the last to be depleted from what I understand.

Like famnd, it took me years to regain my health after medication...and it could have been avoided had I had the proper diagnosis to begin with...a potassium deficiency and sleep apnea.

Take care and good luck!!


Tamsin 09-16-2008 05:10 PM

Re: Alternatives to HCTZ? (Long)
I forgot to add that I'll also be taking a mag supplement everyday.

I'm pretty hopeful this regiment will work for me.

Fingers crossed!

Thanks again! :)

bethsheba 09-17-2008 06:13 AM

Re: Alternatives to HCTZ? (Long)
I'll keep my fingers crossed, too!

Good luck!


jamie007 06-18-2011 03:57 PM

Re: Alternatives to HCTZ? (Long)
Flowergirl, Since you take hctz and seem to know so much about it, maybe you can help me out here.
A few weeks ago I was taking aqbout 10 mgs of hctz (going up from 6.25 to 12.5) very slowly....about day 3 or 4 I noticed more edema in my finger and toes. I had not been urinating more with the hctz and i was drinking the same amount of water as normal. Iknow the package insert says not to take if you have a low urine output. Well I do have a low urine output but never thought of it or knew anything about it till i noticed the swelling worse and thats when I remembered reading that part about low urine output.

So I stopped taking it and the swelling in my toes went away but my fingers are always swollen. When I wake up they are skinny but by late afternoon then are swelling up and stay that way much of the day, well actually all day they go up and down but up for the most part.

So when I was taking even 1/4 of the 25 mg hctz like i am again now, my bp was nice and low, 112 over 80 and readings arond there were nice, except I do have anxiety and it rasies up high when I have anxiety attacks.

So now back on hctz at only 1/4 of the 25mgs, my bp has been very nice, except today a couple times when I was feeling panicky about my inlaws comng. its funny because i was in a cleaning frenzy and stopped dead middle of cleaning and took bp and it was 118 over 79! I laughed as that was unexpected but so nice! See exercise does lower bp i thought to myself.

Ok now for my question...because I do have a low urine output and when I was up to the higher dose I had no more urine output then normal, maybe even less, or less frequent...I'm always care about my sodium intake except for today, I did have some high sodium fast food and my fingers are exceptionally large! Its always mostly my left fingers that are worse then the right. My Dr. did tell me that chronic high blood pressure can also cause this and we will see once I get it under control for a while if it will go down...

Whew! I've typed a lot of words but feel like i've havent said what I'mtrying to say yet, lol. I guess i'm wondering what your opinion is of the low urine output and having less of it on only such a small dose but working for lowering bp because I am on only bystolic and its not doing the trick and I know adding the hctz is helping!

Please let me know what you think, anything at all would be great! I see my Dr. in a couple weeks. I have alotof bloating and going for ultra sound then will see Dr. for results. bloating unrelated to hctz.

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