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Diuretics for Hypertension

Curated by Claudia Shannon / Research Scientist / ishonest

Diuretics are a class of medications that remove water and electrolytes from the body by increasing urination.

They’re often used to treat hypertension, also known as high blood pressure. High blood pressure can be a contributing factor in the development of various forms of heart disease.

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When used as a treatment for hypertension, prescription diuretics can be effective in helping to prevent heart attack and stroke in many people.

Certain foods and herbs may also possess diuretic effects, but there’s less evidence of their effectiveness, and they shouldn’t be used in place of medical diuretics.

Pharmaceutical diuretics

Diuretic medications typically prescribed for high blood pressure are grouped into three main types.

Thiazides

Usually the first line of treatment for hypertension, thiazide diuretics can be used alone or with other drugs for hypertension. Two types of thiazide diuretics are metolazone and hydrochlorothiazide.

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Thiazide-like diuretics — which act like thiazide but may cost less — are also very popular. One of the most commonly prescribed thiazide-like diuretics is chlorthalidone. Studies show that it may be the best diuretic to control blood pressure and prevent death. Indapamide is another thiazide-like diuretic.

Loop diuretics

Loop diuretics remove excess fluid by causing the kidneys to produce more urine.

Although not typically prescribed as the first line of defense for hypertension, loop diuretics are approved for treating high blood pressure, edema associated with congestive heart failure, liver cirrhosis, and renal disease.

A few loop diuretics include furosemide (Lasix), ethacrynic acid (Edecrin), and torsemide (Demadex).

Potassium-sparing
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Potassium-sparing diuretics encourage the body to get rid of fluids and sodium. However, they do this without causing a loss of potassium, which is a vital nutrient.

Examples of potassium-sparing diuretics include triamterene (Dyrenium), eplerenone (Inspra), and spironolactone (Aldactone).

The differences in diuretics

Each of the three types of diuretic medication increases the amount of sodium you excrete through urination, but they affect different areas of your kidneys. Your kidneys are the filters through which toxins and excess fluids are flushed from your body.

When you take a diuretic medication, the drug signals to your kidneys that you need to get rid of more sodium. Water binds to the sodium and is then removed during urination, leaving you with a lower blood volume. The reduction in blood volume slows the rate at which blood flows through your blood vessels, helping to decrease your blood pressure.

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Thiazide and loop diuretics may also cause you to lose potassium in addition to water and sodium. Potassium is an important mineral that maintains healthy fluid levels and regulates heart and muscle function. Your doctor may advise you to take a potassium supplement or to eat foods rich in the nutrient to combat low potassium levels.

Potassium-rich foods include:

  • bananas
  • dried apricots
  • dark chocolate
  • white beans
  • salmon
  • baked potato
  • dates
  • cod
  • Brussels sprouts
  • avocado

Potassium-sparing diuretics don’t pose as much of a threat to your potassium levels. However, they aren’t as effective in treating hypertension as the other types of diuretic medications, so they’re often prescribed along with other drugs.

While thiazide diuretics are the primary treatment method for people who have hypertension-related heart disease, your doctor will tailor your drug regimen to your specific health concerns. Your specific medication may contain more than one type of diuretic agent in a single pill or dose.

Risks and side effects

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Diuretics are generally safe for most people when taken as prescribed.

The most common side effect of diuretics is increased urination. Your potassium, glucose, and cholesterol levels may fluctuate depending on the type of diuretic you’re taking. Your doctor may run blood tests to measure your levels throughout treatment.

Other common side effects can include:

  • headaches
  • dizziness or lightheadedness
  • increased sensitivity to sunlight
  • muscle weakness or cramping

More severe side effects can include:

  • decreased sexual desire (or impotence)
  • irregular heart rate
  • electrolyte abnormalities
  • severe dehydration
  • hyperkalemia (too much potassium in the blood, caused by potassium-sparing diuretics)
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Side effects are likely to decrease over time. Make sure to notify your doctor if you experience uncomfortable or prolonged side effects while taking a diuretic. Your doctor may adjust your dosage or switch you to a different type of diuretic medication.

Natural diuretics

Certain foods and herbal supplements may have a diuretic effect on your body, increasing your urine output.

However, none of the examples listed below have been studied enough to take the place of medication, and it’s important to speak with your doctor before adding any natural alternatives to your blood pressure regime.

Taking a natural diuretic, even unintentionally through your normal diet, along with a pharmaceutical medication could lead to dehydration and other potentially harmful drug interactions.

Ginger root
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Typically known as a root that helps with nausea, studies show that ginger (either in supplement form or via IV) may also help with hypertension.

However, more studies, and recommendations around dosage, have to be done before anything definitive can be stated.

Celery

Celery’s positive effect on blood pressure has been shown in animal studies, but more human trials are needed before it’s known how effective this vegetable really is when it comes to hypertension in humans.

Also of note: Many studies looked at celery extract, which can be much more potent than the vegetable itself.

Garlic
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Garlic has been used in natural medicine for centuries, touted for its anti- inflammatory and antibacterial abilities. Studies also show that garlic may help with hypertension — although aged garlic extract seems to provide the most benefit.

Other foods and plants that have been shown to possibly have a positive effect on blood pressure include:

    tea
  • cilantro
  • coriander
  • saffron
  • lemongrass
  • ginseng

The takeaway

If you’re living with high blood pressure, you and your doctor will decide whether pharmaceutical diuretics are the proper treatment for you.

There are many different kinds of pharmaceutical diuretics available, so if one doesn’t work, don’t worry! Your doctor may also decide to create a treatment plan that includes more than one diuretic.

While there are some foods and herbs that may have diuretic effects, they can’t replace pharmaceutical medication. Talk with your doctor before adding any natural diuretic to your diet, as many of these can interact with other medications.

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