Diuretics have been used successfully for the treatment of hypertension since the mid-1950s.
The exact mechanism of the hypotensive action of diuretics is unknown, despite the fact that they have been used for this purpose in medicine for more than 40 years. At the first stage of application, a decrease in the volume of circulating fluid (LCP) occurs, followed by a decrease in blood pressure and a short-term decrease in cardiac output. Over time, however, cardiac output returns to the previous level, blood pressure remains low, LCP returns to a level slightly lower than it was before the start of treatment, and vascular resistance decreases.
Long-term effects include vasodilation. Some findings suggest that vasodilation is the primary effect of diuretics and may be related to their effects on calcium channels. However, under the conditions of a constant decrease in lCV, the stimulation of the RAAS continues, but this effect is not so great as to level diastoracic vasodilation. However, in some patients, it may be necessary to administer small doses of ACE inhibitors, б -blockers or angiotensin II receptor antagonists to relieve RAAS stimulation (Scheme 5).
There are several classes of diuretics:
1) thiazide or thiazide-like diuretics that block sodium reabsorption at the beginning of the distal tubules;
2) indoline derivatives;
3) loop diuretics, acting proximally and blocking reabsorption in the loop of Henle, have a more pronounced natriuretic effect;
4) potassium-saving diuretics acting on the distal tubules, and, thus, partially interfere with the exchange of sodium for potassium.
Long-acting thiazide diuretics are more effective antihypertensive drugs than loop and indapamide. However, unlike thiazide diuretics, loopbacks and indapamide are effective in renal dysfunction and are therefore preferred in cases of hypertension associated with chronic renal failure. When treating with potassium uretic diuretics in patients who also receive cardiac glycosides and who are obviously suffering from cardiac diseases with ECG changes, ectopic rhythm or arrhythmia, it is recommended to prescribe additional potassium supplements or use potassium-saving diuretics. Distal type diuretics (spiro-lactone, triamterene and amiloride) do not cause hypokalemia, hyperuricemia or hyperglycemia, but have a less pronounced effect than thiazides. Potassium-sparing diuretics can be included in the drug complex instead of adding potassium.