Diuretic therapy: key aspects in hypertension and renal disease

Diuretics are a heterogeneous class of drugs of tremendous importance in both the prevention and treatment of cardiovascular and renal disease. Used as antihypertensives, diuretic-based therapy to lower blood pressure reduces cardiovascular events. In addition to their role as preventive agents, diuretics are critical to the management of several commonly encountered edematous conditions, including chronic kidney disease and the nephrotic syndrome. Because a threshold amount of diuretic is necessary to elicit the intended natriuretic effect, alterations in the pharmacokinetic and pharmacodynamic parameters occurring in the presence of a variety of renal conditions necessitate careful dose titrations and adjustment. Higher doses or more frequent administration may be necessary to maintain the drug level above the diuretic threshold. In refractory cases, diuretics with differing sites of action in the nephron can be combined to potentiate therapeutic effects. Selection of the proper diuretic agent and its dosing strategy are dependent on knowledge of within-class characteristics, as well as a commensurate understanding of the physiology of the disease being treated.