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Long-term diuretic therapy and renal function in essential arterial hypertension
J M Alcazar1, J L Rodicio, L M Ruilope
1Department of Nephrology, 12 de Octubre Hospital, Madrid, Spain.
The American Journal of Cardiology
|May 2, 1990
Summary
Diuretics used for hypertension can cause biochemical side effects, including elevated cholesterol and glucose levels, and proteinuria. Long-term diuretic therapy may preempt the clinical relevance of these events.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Antihypertensive therapy aims to preserve renal function.
- Diuretics are effective for hypertension but can cause biochemical side effects.
- The renal effects of diuretics are significant in long-term therapy.
Purpose of the Study:
- To evaluate the long-term effects of a stepped-care antihypertensive regimen on renal function and biochemical parameters.
- To assess the impact of diuretics on serum cholesterol, glucose, potassium levels, and proteinuria.
Main Methods:
- A 10-year follow-up study of 211 patients with essential hypertension.
- Patients received nonpharmacologic measures, hydrochlorothiazide/amiloride, propranolol, or hydralazine.
- Blood pressure, serum cholesterol, glucose, potassium, and creatinine clearance were monitored.
Main Results:
- Blood pressure was well-controlled across all groups.
- Progressive elevation in total serum cholesterol and glucose was observed, reaching statistical significance after 4 years with diuretic use.
- Proteinuria appeared in 15.2% of patients, associated with decreased creatinine clearance, independent of blood pressure control.
Conclusions:
- Thiazide diuretics may contribute to earlier increases in serum glucose and cholesterol.
- Diuretics can lead to significant renal effects, including proteinuria and decreased creatinine clearance.
- Despite biochemical changes, diuretics may lessen the clinical relevance of forthcoming events.