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[Various principles of treatment of hypertension with diuretics]
Insights
This study introduces a new diuretic treatment strategy for essential hypertension (EH). The individualized approach optimizes drug effectiveness and minimizes side effects in EH patients.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Essential hypertension (EH) management requires effective and safe long-term treatment strategies.
- Current diuretic therapies can lead to refractory reactions and side effects.
Purpose:
- To develop and evaluate a novel, prolonged continuous treatment scheme for essential hypertension (EH).
- To individualize diuretic dosing based on patient sensitivity and optimize natriuresis/mean arterial pressure (AP) ratio.
Summary:
- The proposed scheme involves differentiated drug application, furosemide testing, and switching to hypothiazide or other diuretics to maintain a specific natriuresis/mean AP ratio.
- Procedures to prevent drug resistance and side effects were incorporated.
- The treatment was tested in 110 inpatients with EH (stage IIA and IIB), with 23 continuing outpatient treatment for 6-12 months.
- Patient responses varied: 22% highly sensitive, 40-43% moderately sensitive (requiring intermittent beta-blockers or corinfar), and 35-38% poorly sensitive to diuretics.
Impact:
- The new regimen demonstrated a reduced rate of side effects compared to standard diuretic treatments.
- Identifies patient subgroups based on diuretic sensitivity, guiding personalized hypertension management.
- Provides a framework for optimizing long-term diuretic therapy in essential hypertension.
Abstract:
A scheme of prolonged continuous treatment has been developed for patients with essential hypertension (EH). It is based on the principle of differentiated application of the drug in individualized doses, and furosemide testing with subsequent switching to small doses of hypothiazide or some other diuretic agent conducive to the maintenance of the daily natriuresis/mean AP ratio at 1.9-2.0. A series of procedures are also proposed which prevent the development of refractory reaction to the drug or side-effects. The scheme was tested in the course of diuretic treatment of 110 in-patients with EH, stage IIA and IIB, of which 23 were subsequently treated for 6-12 months on an out-patient basis. It was noted that 22% of EH patients were highly sensitive to diuretics, 40-43% showed moderate sensitivity, so that 2-3 weeks' courses of small doses of beta-blockers or corinfar were needed 4-5 times a year to provide a good hypotensive effect, and 38-35% of patients showed poor sensitivity to diuretics and should preferably be treated with other hypotensive agents. The diuretic treatment according to the new regimen was associated with a reduced rate of side-effects.