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Diuretics help towards the reduction of high blood pressure
Looking at the scales, Vic thought, "What could I possibly have eaten that would cause me to gain 4 pounds in one day?"
On taking inventory, Vic found that he could not possibly have eaten enough extra calories (14,000) to gain that much weight in such a short period. He had, however, consumed more than his share of sodium - a corned beef sandwich with potato chips and two large pickles. That meal undoubtedly contributed to the extra 4 pounds of water weight he was carrying.
A few months later, Vic was diagnosed with high blood pressure, placed on a diuretic medication and advised to limit his sodium intake.
An estimated 65 million Americans have high blood pressure. One major cause, as in Vic's case, is salt sensitivity that causes the body to retain fluids, increasing blood volume and making the heart work harder. When blood pressure is elevated, doctors usually recommend limiting sodium intake to no more than 1,500 milligrams per day.
In addition to that and other lifestyle measures, diuretic medication is recommended by official guidelines as first line treatment. Also known as water pills, diuretics work by causing the kidneys to flush excess sodium and water from the body, which in turn helps relax blood vessel walls.
Although there are many newer and more expensive blood pressure medications available, the guidelines are based in part on the large ALLHAT study published in 2002 in the Journal of the American Medical Association. Among more than 33,000 subjects treated for an average of five years, those taking diuretics were less likely to suffer a stroke, develop congestive heart failure or be hospitalized for heart problems compared to subjects taking calcium channel blockers or ACE inhibitors. They had about the same rate of suffering heart attacks or dying from heart disease.
The good news is that diuretics are considerably less expensive than other hypertension drugs and have a long-term safety record established with over 40 years of use.
Most commonly prescribed for early hypertension are thiazide diuretics. Chlorthalidone was used in ALLHAT, but a more common choice today is hydrochlorothiazide (HCTZ), which has fewer side effects.
Thiazide diuretics can cause the body to flush out potassium as well as sodium, and potassium is needed for muscles and to keep the heart working properly. As a result, thiazide diuretics are often prescribed along with a potassium supplement or with a potassium-sparing diuretic such as triamterene. Vic's pill was a combination of hydrochlorothiazide and triamterene.
Loop diuretics are more powerful and often prescribed for congestive heart failure, liver disease or emergency situations involving fluid retention.
The major side effect of diuretics-and the only one Vic experienced regularly-is frequent urination which usually continues for about four hours after the medication is taken each day.
Other possible but not very common side effects include: lightheadedness when getting up quickly from a sitting or standing position; tiredness, weakness or muscle cramps; dehydration; and skin rash. Some diuretics can also make skin more sensitive to the effects of sunlight.
Men are usually worried about the potential for erectile dysfunction associated with diuretics. However, this effect is probably not as common as believed. Erection problems are associated with hypertension itself, and Vic had difficulty before he started taking medication. Whatever the cause, his ED responded readily to treatment with Viagra.
Diuretics can also raise cholesterol and increase the risk of gout and diabetes-but usually at doses higher than those ordinarily prescribed.
Many patients, particularly those with high readings or blood pressure that's resistant to treatment, may need another medication, along with a diuretic.
Edema, or swelling caused by accumulation of fluid in body cells is associated with a number of serious illnesses such as congestive heart failure and kidney or liver disease. These are illnesses which usually require more powerful diuretics and in higher doses.
When the late President Franklin D. Roosevelt was diagnosed with hypertension, in the days before good treatments were available, he progressed within a decade to severe cardiovascular problems that led to his death. Vic has kept his blood pressure under tight control for 14 years through exercise, diet and one water pill a day.