Diuretics in monotherapy and in combination with other diuretics and non‑diuretics in the treatment of hypertension

Česká verzia

Authors: J. Špinar ¹; L. Špinarová ²; J. Vítovec ²
Authors place of work: Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MU Dr. Jindřich Špinar, CSc., FESC ¹; I. interní kardio‑angiologická klinika Lékařské fakulty MU a FN u sv. Anny v Brně, přednostka prof. MU Dr. Lenka Špinarová, Ph. D., FESC ²
Published in the journal: Vnitř Lék 2013; 59(6): 486-494
Category: 80th birthday prof. MUDr. Karla Horkého, DrSc., FACP (Hon.)

Summary

Diuretics belong to the basic group of medicines for the treatment of hypertension and heart failure. In the case of hypertension treatment, their main indication is higher age and isolated systolic hypertension. In the case of heart failure they are used for the treatment of swellings and shortness of breath. The most frequently prescribed group of diuretics is thiazides and similar products. In patients with renal insufficiency, loop diuretics are administered. In the case of hypertension, diuretics are mainly used in the combination treatment. The most frequently used diuretic in combination is again hydrochlorothiazide, which is combined with renin‑angiotensin system blockers. It is mainly the combination of an ACE inhibitor + indapamide that seems to be modern and promising, and it is, on the basis of large clinical trials, recommended also for diabetics (ADVANCE) or for secondary prevention following a cerebrovascular accident (PROGRESS) or for the elderly (HYVET). Also a combination of two diuretics is popular – mainly hydrochlorothiazide + amiloride. A combination of a beta‑blocker and diuretic is less suitable.

Key words:
diuretics – hypertension – monotherapy – combination

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