Discussing Pharmacology Diuretics

Discussing Pharmacology Diuretics
The Chosen Article
Burnier, M., Bakris, G., & Williams, B. (2019). Redefining diuretics use in hypertension: why select a thiazide-like diuretic?. Journal of hypertension, 37(8), 1574–1586. https://doi.org/10.1097/HJH.0000000000002088

Summary of the Article

According to Burnier et al. (2019), diuretics are listed as one of the first-line treatments of hypertension in various guidelines. However, there are significant differences in the different diuretics’ safety and efficacy; hence, distinctions have begun to be made between the non-thiazide and the thiazide-like diuretics. The article’s main aim is to reinstate and affirm the use of diuretics as a fundamental pharmacologic approach in the management of hypertension. It also discusses the populations that can benefit from the diuretics and unearth the main variations between the thiazide and thiazide-like diuretics.

In the article, various populations have been postulated to benefit from the diuretics. For instance, patients who are hypertensive and have type 2 diabetes are posited to benefit more from the diuretics because they are at increased risk of fluid overload and heart failure. Additionally, the elderly also benefit from the use of diuretics. The available data support the use of diuretics to manage hypertension in the elderly, specifically indapamide, and it has been proven by various clinical trials to be very useful. In patients with stroke history, the utilization of indapamide and angiotensin-converting enzyme inhibitor is very beneficial. This is based on placebo-controlled trials that were conducted. Other populations that benefit from the diuretics include the black and Caribbean descent and patients with salt-sensitive hypertension, as illustrated in Burnier et al. (2019).

The article also discusses the preference of thiazide-like diuretics over thiazide diuretics. Several guidelines preferred the utilization of the thiazide-like diuretics. This is mainly based on their ability to lower blood pressure, duration of action, and data available on the cardiovascular endpoint. In blood pressure reduction, the thiazide-like and thiazide diuretics have the same effects on lowering blood pressure; however, when the analysis is based on potency and dose-response, significant differences emerge. The article also talks about the tolerability of the diuretics, clinical endpoints, mortality, end-organ damage, and vascular health regarding the two classes of diuretics (Burnier et al., 2019).

According to Burnier et al. (2019), thiazide-like diuretics’ risk-benefit ratio is more favorable than thiazide diuretics. Volume control becomes the primary baseline when a diuretic is to be chosen. In most cases, patients that need to control their blood pressure, fluid volumes and prevent cardiovascular morbidity and mortality benefit more from the use of thiazide-like diuretics.

Description of the Pharmacodynamics of the Chosen Diuretic

The chosen diuretic is indapamide. This is a sulfonamide diuretic. It is considered as an effective anti-hypertensive and also prevents end-organ damage. It leads to loss of water and electrolytes and can lead to diuresis if higher doses are administered. Additionally, the diuretic can lead to severe electrolyte imbalances such as hypokalemia. Moreover, the renal excretion of sodium, magnesium, and chloride can also create electrolytes’ imbalances (Macfarlane et al., 2019).

According to Liang et al. (2017), the drug acts on the distal convoluted tubule’s proximal segment. It leads to the inhibition of the Na+/Cl- cotransporter and causes the reabsorption of sodium, leading to the retaining of water and sodium in the lumen for excretion. This then reduces the blood pressure by lowering the cardiac output, venous return, and plasma volume. Moreover, it has been established that indapamide, among other thiazide-like diuretics, has blood-lowering effects other than the diuresis mechanism. Indapamide also leads to a reduction in calcium excretion via urine and increases aldosterone and plasma renin.

References

Burnier, M., Bakris, G., & Williams, B. (2019). Redefining diuretics use in hypertension: why select a thiazide-like diuretic?. Journal of hypertension, 37(8), 1574–1586. https://doi.org/10.1097/HJH.0000000000002088

Liang, W., Ma, H., Cao, L., Yan, W., & Yang, J. (2017). Comparison of thiazide-like diuretics versus thiazide-type diuretics: a meta-analysis. Journal of cellular and molecular medicine, 21(11), 2634–2642. https://doi.org/10.1111/jcmm.13205

Macfarlane, T. V., Pigazzani, F., Flynn, R., & MacDonald, T. M. (2019). The effect of indapamide vs. bendroflumethiazide for primary hypertension: a systematic review. British journal of clinical pharmacology, 85(2), 285–303. https://doi.org/10.1111/bcp.13787

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