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Related Concept Videos

Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

505
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
505
Antihypertensive Drugs: Action of Diuretics01:16

Antihypertensive Drugs: Action of Diuretics

891
Diuretics are antihypertensive drugs used to treat hypertension resulting from sodium and water retention. Sodium, vital for fluid balance and nerve or muscle function, is regulated by the kidneys through millions of nephrons. Blood enters nephrons via afferent arterioles, which branch into capillaries called glomeruli. These filter blood plasma, allowing water and solutes, like sodium ions, to pass through capillary walls into Bowman's capsule. The filtrate then flows through various...
891
Antihypertensive Drugs: Thiazide-Class Diuretics01:15

Antihypertensive Drugs: Thiazide-Class Diuretics

911
Thiazide diuretics are sulfonamide derivatives featuring a benzothiadiazine ring system in their molecular structure. Based on this structure, thiazide diuretics can be categorized into two groups: thiazide-type and thiazide-like diuretics. Thiazide-type diuretics, including hydrochlorothiazide and chlorothiazide, consist of a benzothiadiazine backbone with an attached sulfonamide group. Thiazide-like diuretics, such as chlorthalidone and indapamide, lack the thiazide ring but demonstrate...
911
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

34
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
34
Antihypertensive Drugs: Potassium-Sparing Diuretics01:28

Antihypertensive Drugs: Potassium-Sparing Diuretics

796
Liddle syndrome is a genetically inherited form of hypertension characterized by the overactivity of epithelial sodium channels in the nephron, the functional unit of the kidney. This heightened activity leads to increased sodium reabsorption and excessive excretion of potassium. To counteract this, potassium-sparing diuretics such as amiloride are used. They function by blocking these sodium channels, thereby reducing the influx of sodium into the epithelial cells and minimizing the loss of...
796
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

526
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
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Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
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Are Diuretics a Clandestine Risk Factor for Patients With Treatment-Resistant Hypertension?

Bertram Pitt1, Christopher S Wilcox2

  • 1Department of Cardiology, University of Michigan, Ann Arbor (B.P.).

Hypertension (Dallas, Tex. : 1979)
|May 29, 2025
PubMed
Summary

Diuretics for resistant hypertension may increase cardiovascular and kidney risks by not blocking aldosterone. Earlier use of mineralocorticosteroid receptor antagonists with diuretics is suggested to improve outcomes.

Keywords:
blood pressurediureticseplerenoneinflammationreactive oxygen species

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Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Treatment-resistant hypertension (TRH) management often involves diuretics to reduce fluid volume.
  • Diuretics alone may be insufficient in TRH, potentially leading to heart failure, cardiovascular mortality, and chronic kidney disease (CKD) progression.
  • Aldosterone and mineralocorticosteroid receptor (MR) activation are implicated in TRH pathophysiology.

Purpose of the Study:

  • To review the evidence on diuretic therapy risks in TRH.
  • To evaluate the role of MR antagonists in conjunction with diuretics for TRH.
  • To determine optimal timing for MR antagonist initiation in TRH management.

Main Methods:

  • Literature review of studies on diuretic therapy and MR antagonists in TRH.
  • Analysis of evidence linking diuretic use to cardiovascular and renal outcomes.
  • Examination of the impact of aldosterone and MR activation in TRH.

Main Results:

  • Diuretic therapy for TRH may pose hidden risks for cardiovascular and renal disease progression.
  • These risks can be masked by the blood pressure-lowering effects of diuretics.
  • Inadequate suppression of aldosterone and MR signaling contributes to these risks.

Conclusions:

  • Earlier co-prescription of MR antagonists with diuretics may be necessary for TRH patients.
  • Delaying MR antagonists to fourth-line treatment might negate diuretic benefits and increase risks.
  • Further clinical trials are needed to validate the optimal use of MR antagonists in TRH.