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To treat hypertension only in patients who have an estimated GFR 30 mL/minute; these diuretics are given at least twice a day (except for torsemide which can be given once a day).All diuretics except the potassium-sparing distal tubular diuretics (eg, spironolactone) cause significant potassium loss, so serum potassium is measured monthly until the level stabilizes. Unless serum potassium is normalized, potassium channels in the arterial walls close and the resulting vasoconstriction makes achieving the blood pressure (BP) goal difficult. Patients with potassium levels3.5 mEq/L (spironolactone, triamterene, amiloride) may be added. Addition of a potassium-sparing diuretic or potassium supplements is also recommended for patients who are also taking digoxin, have a known heart disorder, have an abnormal ECG, have ectopy orarrhythmias, or develop ectopy or arrhythmias while taking a diuretic. In most patients with diabetes, thiazide-type diuretics do not affect control of diabetes. Uncommonly, diuretics precipitate or worsen type 2 diabetes in patients with metabolic syndrome.A hereditary predisposition probably explains the few cases of gout due to diuretic-induced hyperuricemia. Diuretic-induced hyperuricemia without gout does not require treatment or discontinuation of the diuretic.Diuretics may slightly increase mortality in patients with a history of heart failure who do not have pulmonary congestion, particularly in those who are also taking an ACE inhibitor or angiotensin II receptor blocker and who do not drink at least 1400 mL (48 oz) of fluid daily. The increased mortality is probably related to diuretic-induced hyponatremia and hypotension.1. Roush GC, Ernst ME, Kostis JB, Tandon S, Sica DA. Head-to-head comparisons of hydrochlorothiazide with indapamide and chlorthalidone: antihypertensive and metabolic effects. Hypertension 65(5):1041-1046, 2015. doi:10.1161/HYPERTENSIONAHA.114.050212. Ishani A, Cushman WC, Leatherman SM, et al. 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2025-04-21
User8583

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2025-04-10
User6960

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2025-04-14
User4206

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2025-04-02

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