Do diuretics have antihypertensive properties independent of natriuresis?
To ascertain whether diuretics have an antihypertensive effect independent of natriuresis, 12 stable patients on maintenance hemodialysis underwent a crossover evaluation with hydrochlorothiazide, 50 mg daily, metolazone, 5 mg daily, or placebo in 4-wk treatment periods for 6 mo. Compliance was assured by pill counts and serum drug concentrations. All patients had daily urine less than 100 ml. Pre- and postdialysis blood pressure, body weight, plasma volume, and plasma renin activity were monitored. Over the 6-mo study period there were no statistically significant changes in any parameter related to diuretic therapy. It is concluded that a functioning kidney with the ability to respond to diuretics with a natriuresis is necessary for the antihypertensive action of diuretics. Direct vascular effects of diuretics to lower peripheral resistance could not be demonstrated in this unique patient population.
D000328:Adult; D000959:Antihypertensive Agents; D001794:Blood Pressure / Q000187:drug effects; D002986:Clinical Trials as Topic; D004232:Diuretics / Q000494:pharmacology*; D004311:Double-Blind Method; D006801:Humans; D006852:Hydrochlorothiazide / Q000494:pharmacology; D007676:Kidney Failure, Chronic / Q000503:physiopathology; D008297:Male; D008788:Metolazone / Q000494:pharmacology; D008875:Middle Aged; D009318:Natriuresis; D010919:Placebos; D006435:Renal Dialysis
D000959:Antihypertensive Agents; D004232:Diuretics; D010919:Placebos; D006852:Hydrochlorothiazide; D008788:Metolazone