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Diuretics for the Treatment of Hypertension

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Pathophysiology and Pharmacotherapy of Cardiovascular Disease

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Abstract

Diuretics are agents commonly used in diseases characterized by excess extracellular fluid, including chronic kidney disease, nephrotic syndrome, cirrhosis, and heart failure. Diuretics are also commonly used either as monotherapy or in combination with other antihypertensive agents in the management of hypertension. Multiple diuretic classes, including thiazide-type diuretics, loop diuretics, and potassium-sparing diuretics, are used to treat patients with these diseases. An understanding of what determines a patient’s response to a diuretic is a prerequisite to the correct use of these drugs. The response of patients with these diseases to diuretics, which is related to the dose, is best described by a sigmoid curve whose contour can become distorted by any of the several sodium-retaining states that are directly or indirectly associated with renal disease. The pharmacodynamic effect of diuretics as used in the treatment of hypertension involves both a volume removal element and more long-term vasodilation. Diuretic actions are of considerable importance to patients who have renal disease, as their effective use assists in extracellular fluid volume control, reducing excretion of protein in urine and lessening the risk of developing hyperkalemia. Diuretic-related adverse events that involve the uric acid, sodium, and potassium axes are not uncommon; therefore, the clinician must be vigilant in looking for biochemical disturbances. As a result of diuretic-related adverse events, clinicians must be resourceful in the dose amount and frequency of dosing.

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  1. Section of Clinical Pharmacology and Hypertension, Division of Nephrology, Virginia Commonwealth University Health System, 980160, MCV Station, Richmond, VA, 23298-0160, USA

    Domenic A. Sica MD

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  1. Domenic A. Sica MD
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Correspondence to Domenic A. Sica MD .

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  1. Center for Drug Evaluation and Research Division of Cardiovascular and Renal Products, US Food and Drug Administration, Silver Spring, Maryland, USA

    Gowraganahalli Jagadeesh

  2. Pharmacology Unit, AIMST University, Bedong, Malaysia

    Pitchai Balakumar

  3. Center for Drug Evaluation and Research Division of Cardiovascular and Renal Products, US Food and Drug Administration, Silver Spring, Maryland, USA

    Khin Maung-U

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© 2015 Springer International Publishing Switzerland

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Sica, D.A. (2015). Diuretics for the Treatment of Hypertension. In: Jagadeesh, G., Balakumar, P., Maung-U, K. (eds) Pathophysiology and Pharmacotherapy of Cardiovascular Disease. Adis, Cham. https://doi.org/10.1007/978-3-319-15961-4_38

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  • DOI: https://doi.org/10.1007/978-3-319-15961-4_38

  • Publisher Name: Adis, Cham

  • Print ISBN: 978-3-319-15960-7

  • Online ISBN: 978-3-319-15961-4

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