Use of Diuretics in Pharmacologic Treatment of Hypertension
In all forms of hypertension, sodium retention is the principal mechanism that causes a rise in blood pressure. Thus, management therapies of hypertension aim at increasing urinary excretion of the excess sodium. Alongside Calcium channel blockers, thiazide diuretics are regarded as the first-line treatment options for hypertension. Moreover, studies show that treatment with diuretics is accompanied by a significant reduction in deaths caused by hypertension comorbidities such as stroke and major cardiovascular events. On a somewhat negative side, treatment with diuretics is associated with adverse effects such as electrolyte imbalances and the risk of developing type 2 Diabetes Mellitus. Thus, the paper will offer a critical analysis of Thiazide diuretics, their pharmacodynamic properties, and the critical issues involved in using them to treat hypertension.
As discussed earlier, diuretics are the first-line drugs in managing hypertension due to their benefits in reducing fluid load In the body and reducing morbidity and mortality due to hypertension—however, the mechanism through which these drugs lower blood pressure is poorly understood. One of the most postulated mechanisms of these drugs is the inhibition of Na+/Cl− cotransporter (NCC) in the renal distal convoluted tubule. The NCC’s primary role is the facilitation of reabsorption of sodium ions from the distal convoluted tubules back to the interstitium. Thus, Thiazide Diuretics act by blocking this cotransporter, which leads to a reduction in the amount of sodium reabsorbed. Consequently, this increases the amount of fluid lost in the urine and a subsequent decrease in the Extracellular Fluid (ECF).
According to the article, the management of hypertension using Thiazide Diuretics is beneficial in many ways. For instance, the American Heart Association (AHA) recommends diuretics in managing hypertension among black patients. Also, some studies emphasize the importance of treating patients with a history of stroke with a diuretic. Moreover, data from various clinical trials support the use of Thiazide Diuretics, such as chlorthalidone, to manage hypertension in the elderly. Finally, thiazide diuretics are useful in hypertensive patients who suffer from type 2 Diabetes Mellitus. In these patients, the Renin-Angiotensin System inhibitors (RAS) are considered first-line therapy. However, due to the possibility of fluid retention with a concomitant risk of heart failure, the use of diuretics in these patients has proved productive.