Blood pressure lowering efficacy of loop diuretics for primary hypertension

Abstract

Based on the limited number of published RCTs, the systolic/diastolic blood pressure 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 are 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 with loop diuretics because of the short duration of the trials and the lack of reporting of adverse effects in many of the trials.

Terfestatins B and C, New p-Terphenyl Glycosides Produced by Streptomyces sp. RM-5–8

“…10 While compounds that influence inflammatory cascades and osmotic disturbance have been found to reduce this form of insult in preclinical models, none are effective in countering the adverse effects of chronic EtOH dependence in a clinical population. Additionally, loop diuretics such as furosemide produce orthostatic hypotension that may be markedly enhanced by concomitant EtOH intake, 18 while drugs approved for the treatment of alcohol dependence also lack efficacy against the neurodegenerative effects of binge-like or chronic ethanol exposure. Thus, the identification of novel compounds, such as 1 , with the potential to address the debilitating neurodegenerative aspects of EtOH dependence offer significant translational potential.…”

Augmented antihypertensive effect of a fixed combination formula of candesartan and hydrochlorothiazide combined with furosemide in a patient on peritoneal dialysis

“…Thiazides act on the distal renal tubules to inhibit sodium chloride (NaCl) cotransport, enhancing urinary sodium excretion. In contrast, loop diuretics act on the ascending limb of Henle's loop to inhibit NaCl reabsorption [4][5][6]. Such diuretic effects may last considerably longer in the former and shorter in the latter, possibly yielding additive or synergistic diuretic effects.…”

“…Their study suggests that the combined use of two diuretics with different pharmacological modes of action may serve to better the patient's fluid management. The effectiveness of combined use of diuretics has also been evaluated in the limited number of trials elsewhere [4,5].…”

“…In practice, loop diuretics in combination with thiazides have occasionally been used in patients with advanced CKD, especially when patients did not respond well to loop diuretics alone [2,3]. Unfortunately, effectiveness of combined use of diuretics has been evaluated in a limited number of trials [4][5][6]. Knauf et al [7] addressed the efficacy of hydrochlorothiazide (HCTZ) and furosemide in patients with advanced CKD.…”

Aging in blood vessels. Medicinal agents FOR systemic arterial hypertension in the elderly

“…Treatment with furosemide, has been related to alterations of serum levels of sodium, potassium, and creatinine, particularly in patients with high risk for electrolyte imbalance in the presence of liquid loss. Previous studies have documented that it increases mortality particularly when the daily dose is 50 mg (Musini et al, 2012). Furthermore, high doses of furosemide (1-3 g daily) may be associated with ototoxicity (Dini et al, 2013;Sica et al, 2011).…”