Combination of converting enzyme inhibitor with diuretic for the treatment of hypertension

Article Abstract:

The use of diuretic drugs has been the cornerstone of treatment for hypertension, and diuretics have traditionally been the first choice for initial treatment of high blood pressure. However, the side effects of diuretics have resulted in increasing avoidance of diuretic therapy. Angiotensin-converting enzyme (ACE) inhibitors are antihypertensive drugs with few side effects, but unfortunately are effective as a single drug in only half of hypertensive patients. The use of two antihypertensive agents to control a patient's blood pressure requires several decisions, and there is some difference of opinion about this treatment option. However, consideration of effectiveness, cost, and side effects suggests that a combination of ACE inhibitors with diuretics may be the best choice. Besides their overall antihypertensive effect, diuretics also stimulate some reflexes which act to elevate blood pressure. The loss of sodium which occurs with diuretics stimulates the renin-angiotensin-aldosterone system, which tends to counteract the effects of the diuretic treatment. The addition of ACE inhibitors prevents this, and permits effective reduction of blood pressure with a smaller dose of diuretic. The reduction of sodium in the body also stimulates the sympathetic nervous system, which tends to raise blood pressure. But the ACE inhibitors dampen the reflex response of the sympathetic nervous system, without altering the baseline level of activity. The synergistic effects of diuretics and ACE inhibitors are particularly important in elderly patients and black patients. The elderly are at particular risk for the complications introduced when diuretics upset electrolyte (sodium and potassium) balance. Black patients have a uniformly better response to diuretics than whites, but are also more prone to developing low blood potassium from their use. In conclusion, especially in the elderly and black populations, the combination of diuretics and ACE inhibitors achieves the therapeutic effect of diuretics alone at doses which prevent the more serious side effects. (Consumer Summary produced by Reliance Medical Information, Inc.)

ACE inhibitors, Angiotensin converting enzyme inhibitors, Antihypertensive drugs, Antihypertensive agents, Diuretics

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Hypertension and sudden death: disparate effects of calcium entry blocker and diuretic therapy on cardiac dysrhythmias

Article Abstract:

The effects of medications in lowering blood pressure on dysrhythmias, or abnormal rhythms of the heartbeat, were evaluated in thirteen hypertensive (high blood pressure) patients taking calcium entry blockers, which decrease the heart's demand for oxygen and thereby cause low blood pressure, and ten hypertensive patients taking hydrochlorothiazide, a diuretic that can lower blood pressure. Arterial blood pressure fell to a similar extent in both groups, but the mass of the left ventricle, which pumps oxygenated blood from the heart to the body, decreased only in the patients receiving the calcium entry blockers. The prevalence of premature beats in the ventricle decreased by seventy-four percent in the calcium entry blocker group, and other abnormal rhythms associated with the left ventricle, such as tachycardia, were abolished. The prevalence of these dysrhythmias was unchanged in patients receiving hydrochlorothiazide. It is concluded that antihypertensive therapy with calcium entry blockers reduces left ventricular mass and the prevalence and severity of ventricular dysrhythmias. Whether these effects will improve the prognosis of left ventricular hypertrophy and the risk of sudden death is not known.

Prevention, Arrhythmia, Hydrochlorothiazide, Calcium channel blockers

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