Comparison Of Diuretics Research Articles

Comparison of diuretics and fluid expansion in the initial treatment of patients with normotensive acute pulmonary embolism: a systematic review and meta-analysis

BackgroundRight ventricular (RV) dysfunction is the main cause of death in patients with normotensive acute pulmonary embolism (PE). The optimal management for this subset of patients remains uncertain. This systematic...

Diuretics: again the first step in the treatment of most patients with hypertension

The results and interpretations of the most recent controlled clinical trials on antihypertensive drugs have fuelled the debate about the drug that should be used to begin treatment for hypertension. Every comparison of diuretics with other drugs has shown that the benefits of diuretics are equivalent to, or better than, other options. These findings, together with other practical reasons, such as left ventricular mass reducing effect, easy administration, few side effects and low cost, suggest that diuretics should regain their primacy as the first step in drug management of hypertension.

Hemodynamic effects of antihypertensive agents: A comparison of diuretics, beta-blockers, calcium antagonists, and angiotensin converting enzyme inhibitors

A total of 121 patients with essential hypertension were treated with a diuretic, beta-blocker, calcium antagonist, or angiotensin converting enzyme (ACE) inhibitor. Hemodynamic assessments were made before and after 3 months of treatment. After 30 minutes of rest in the supine position, the patients' blood pressure, cardiac output, systolic time intervals, total peripheral resistance, and volume-elasticity index were measured. Plasma renin activity in most cases was measured with a furosemide-loading test (in an upright position) before treatment. Only patients who had a decrease in mean arterial pressure of >13 mmHg before and after treatment were included in the analysis. The principal hemodynamic change before and after treatment with diuretics and beta-blockers was a decrease in cardiac output; the main change with calcium antagonists and ACE inhibitors was a decrease in total peripheral resistance. Based on their hemodynamic characteristics, patients were placed in a high cardiac output group or high vascular resistance group. Each group was further divided into high-renin, normal renin, or low-renin groups. In the high cardiac output group: the high-renin group responded best to beta-blockers, the normal renin group to diuretics or beta-blockers, and the low-renin group to diuretics. The high vascular resistance group responded best to calcium antagonists or ACE inhibitors, regardless of the plasma renin activity. Our results indicate that an antihypertensive agent should be selected not only for its effects on blood pressure but also for its effects on hemodynamics and renin activity.