Friday, April 6, 2012

Read this and check your blood pressure medications

Thiazide diuretics have become the most commonly drug prescribed for the treatment of high blood pressure in the United States. In 2008 , 47 thousand prescriptions were written for HCTZ and another 87.1 million written for various  medication combinations with  HCTZ ( hydrochlorathiazide ).

I was never a fan of HCTZ for 2 reasons :
   #1  there were hints that they interfered with insulin and increased the risk of developing Diabetes
   #2  People taking HCTZ  , slowly and silently, deplete body Potassium stores . This depletion
         especially effects muscles.
         Maintaing a normal blood potassium level is important  for proper heart function.

          Replacing the lost  potassium is difficult .

          Many people  rely on eating a banana each day as their potassium source rather than
          take a KCL supplement. One banana replaced some of the potassium but it would take one 40 inch
          banana to replace all of the loss.

          I became  more aware of this  total body potassium depletion problem, when patients taking HCTZ
           or any diuretic ,was admitted  to the hospital for an acute condition requiring IV fluids
       

Note: there are also thiazide -like diuretics , chlothalidone and Metolazone that have a similar action but have a different structure. Pay attention this may be important. keep reading.



There is an interesting article published in The American Journal Of Medicine (2011) 124,896-898


 Half a Century of Hydrothiazide: facts , Fads ,Fiction , and Folly
 Franz H. Messerti,MD and Sripal Bangalore,MD, MHA


I will just review the main points.


   * Hydrochlorathiazide is the most commonly prescribed antihypertensive drug

   * Antihypertensive Efficacy
         They reviewed 19 studies with over 1400 patients and found that HCTZ in its usual dose 12.5
          to 25mg/day reduced  24 hour ambulatory blood pressure  6.5 systolic/ 4.5 diastolic.


   * Effect on Morbidity and Mortality
          They found that there is no evidence that HCTZ in doses , of 12.5 to 25 Mg/day , reduced
           myocardial infarction , Stroke , or Death
           Higher doses  ( 50 mg ) increased the risk of cardiac arrest
           MRFIT ( multiple risk factor intervention trial ) Patients receiving HCTZ  had a 46% increase 
           in cardiovascular mortality. Patients in the same study taking Chlorathalidone ( a thiazide- like )
           had a 58 % decrease in mortality.


   * Aherence to the Thiazides
            A meta-analysis of 17 studies suggest that adherence to diuretics is worse than any other drug
           class. One study  found that only 39% of patients started on a diuretic remained on it at 1 year.
            
     * Unpleasant side effects include
          frequent urination , erectile dysfunction , fatigue ,leg cramps ,  muscle weakness due to low
         Potassium plus the other things mentioned above.


comment:
      This article gives me more reasons to avoid prescribing Hydrochlorothiazides( HCTZ). 
       A low salt diet may be a better choice .

       Remember that a normal blood potassium may miss more serious potassium  depletion
       problems caused by diuretics .


       Review your blood pressure medications and discuss side effects and Medication choices with
       your doctor.


 Have fun , Be Smart and be a wise informed consumer . 
 David Calder,MD
       
         
        
        .
   
   

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  2. Thanks for your comment. David Calder,MD

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  8. I became more aware of this total body potassium depletion problem, when patients taking HCTZ or any diuretic ,was admitted to the hospital for an acute condition requiring IV fluids. Homepage

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Your comments and questions are appreciated. David Calder,MD