Blood pressure lowering efficacy of loop diuretics for primary hypertension

Abstract

Based on the limited number of published RCTs, the SBP/DBP lowering effect of loop diuretics is modest -8/-4 mmHg and is likely an overestimate due to the high risk of bias in the included studies. There is no clinically meaningful BP lowering differences between different drugs within the loop diuretic class. The dose ranging effects of loop diuretics could not be evaluated.The review did not provide a good estimate of the incidence of harms associated because of the short duration of the trials and the lack of reporting of adverse effects in many of the trials.

Diuretic use, increased serum urate levels, and risk of incident gout in a population‐based study of adults with hypertension: The Atherosclerosis Risk in Communities cohort study

“…Data on loop diuretics and serum urate are, however, more limited. Pooled analysis of 2 small studies found no change in serum urate after the initiation of a loop diuretic (16). A UK study of the 25 participants using a diuretic before the onset of gout, found that 16 (64%) continued the diuretic (24).…”

“…Additionally, previous clinical trials have not been designed to study gout as an outcome but rather focused on the change in serum urate levels (3–5, 14). Furthermore, the studies of diuretics have focused on thiazide diuretics, and few studies have assessed the association of loop diuretics with serum urate and the risk of gout (15, 16). To our knowledge, no population-based study has jointly evaluated the association of diuretic use with serum urate level and risk of incident gout.…”

Effects of furosemide and the combination of furosemide and the labeled dosage of pimobendan on the circulating renin-angiotensin-aldosterone system in clinically normal dogs

“…The blood pressure-lowering properties of loop diuretics are typically attributed to loss of fluid and sodium, although these effects have been determined in rats and human patients parenterally administered loop diuretics regardless of volume status, which suggests the possibility of a direct vasodilatory mechanism. [22][23][24] This decrease in blood pressure is typically modest and is mediated and modified by the degree of sodium depletion as well as renin, angiotensin II, and prostaglandin concentrations. [22][23][24] The initial mild decrease in blood pressure in dogs that received furosemide alone may have been attributable to a direct vascular effect of furosemide.…”

“…[22][23][24] This decrease in blood pressure is typically modest and is mediated and modified by the degree of sodium depletion as well as renin, angiotensin II, and prostaglandin concentrations. [22][23][24] The initial mild decrease in blood pressure in dogs that received furosemide alone may have been attributable to a direct vascular effect of furosemide. 22 However, blood pressure did not change significantly in the dogs that received the combination of furosemide and pimobendan, despite suspected but unproven volume depletion and a possible furosemide-induced decrease in systemic vascular resistance.…”