In patients with diabetes mellitus, diuretics in arterial hypertension are rarely used as monotherapy, more often in combination with drugs of the considered groups. Among the various classes of diuretics (thiazide, loop, potassium-saving, osmotic) it is advisable to use drugs that do not impair glucose tolerance and lipid metabolism. When kidney function is abnormal, the purpose of potassium-saving diuretics is not indicated. Preference in treating patients with diabetes mellitus is currently given to loop diuretics (furosemide, ethacrynic acid) , which act throughout the ascending part of the loop of Henle and, to a lesser extent than thiazides, affect the carbohydrate and lipid exchange. Drug new generation Arifon-retard (Indapamid) is the drug of choice in patients with diabetes mellitus, and, according to research data, its use is not accompanied by changes in cholesterol levels or impaired carbohydrate metabolism; renal function also does not suffer. The drug has a dual mechanism of antihypertensive action: at the level of the renal nephron and directly on the vessel wall (vasodilation and reduction of OPS).
Side effects of diuretic therapy include impaired sexual function in men, which they cause more often than other first-line drugs. In addition, metabolic side effects are possible: hypocalcemia, hyperuricemia, hyperlipidemia, increased insulin resistance , hypercalcemia .
Currently, a number of studies are being conducted aimed at selecting the optimal therapy for patients with hypertension and diabetes or hypertension and obesity, and the combination of a “small dose of diuretic + ACE inhibitor” is considered as a contender for the role of “ideal” initial therapy for hypertension.
Combined use of diuretics with other antihypertensive drugs. Diuretics remain one of the preferred drug prescriptions from which the actual therapy of hypertension begins. In combination with – blockers, ACE inhibitors, angiotensin II receptor blockers and calcium channel blockers, it is possible to achieve normalization of blood pressure in approximately 75-80%. Recent data confirmed that combination therapy, including a diuretic, is more effective than combination therapy without it.
Some drugs that include diuretic are available on the Russian market. Among them, caposid (25 mg of captopril / 25 mg of hydrochlorothiazide), Diovan HCT (valsartan / thiazide), Tenoretic (atenolol / chloraltalidone).