In addition to lowering blood pressure, diuretics (dye-er-etiks) are used in the treatment of edema and congestive heart failure. There are several different classes of diuretics - Thiazide, Loop, and Potassium sparing - each of which have their own unique uses.
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Thiazide diuretics include hydrochlorothiazide (Diuril) and chlorthalidone (Thalitone). They can be used by themselves or in combination with ACE inhibitors and ARBs for a more potent effect on lowering blood pressure. Thiazide diuretics are less effective in advanced stages of kidney disease. Their main side effects can include low sodium, potassium, and magnesium levels. In addition, it can elevate uric acid levels in some patients. If you have gout, be careful when taking a Thiazide diuretic. Moreover, they may also cause dehydration. Call your doctor if you feel dizzy or lightheaded as this can be a sign that your blood pressure may be too low.
Loop diuretics include furosemide (Lasix), bumetanide (Bumex), and torsemide (Demadex). They are used more for the treatment of edema that can be seen in the higher stages of chronic kidney disease, though they can have modest effects on blood pressure. The main side effects can include low potassium and magnesium levels. When on a loop diuretic, your doctor may have you obtain blood work on a frequent basis and will ask you to weigh yourself daily. If you experience a significant change in your weight - either gaining or losing too much - over a day or two, it will require a change in dosage of your medication. Again, call your doctor if you feel dizzy or lightheaded as this can be a sign that your blood pressure may be too low.
Finally, potassium-sparing diuretics can raise potassium levels. They need to be used carefully in advanced stages of CKD (GFR < 30 ml/min), as the risk of high potassium can hinder their use. Potassium-sparing diuretics include spironolactone (Aldactone), eplerenone (Inspra), amiloride (Midamor), and triamterene. All of them can reduce proteinuria, and spironalactone (Aldactone) and eplerenone (Inspra) are also used in the treatment of heart failure. In addition to high potassium levels, if you are taking spironolactone (Aldactone), a significant side effect is breast and nipple tenderness.
This requires decreasing or even totally stopping the medication for the symptoms to disappear. As with all diuretics and blood pressure medications, call your doctor if you feel dizzy or light-headed as this can be a sign that your blood pressure may be too low.
Use of Alpha Blockers
Alpha blockers lower blood pressure and are commonly used in men with enlarged prostates, as they can help improve urine flow and stream. Examples of medications prescribed from this class include doxazosin (Cardura) and terazosin (Hytrin).
Alpha blockers can cause significant dizziness when standing up, specifically when first starting the medication; be careful and stand up slowly when taking this medication. If you have significant light headedness or dizziness, call your doctor right away.
In addition to the many classes of medications used for blood pressure that were just described, there are also others. When talking to your doctor about them, it is important that you ask about their possible side effects and safety in kidney disease.
Screening for Resistant Hypertension
Despite being on a several different medications, it may be difficult to get your blood pressure under control. If "white-coat syndrome" - high blood pressure in the doctor's office but normal at home - is not present, then other causes need to be investigated.
These can include kidney disease, obesity; vascular disease (problems with blood vessels) of the kidney, and sleep apnea. Note that there are many other causes of high blood pressure; your doctor may have started investigating these causes, or may have consulted a kidney specialist for further treatment and evaluation. To find out more, you can check out Hypertension Kidney Disease.