Diuretics Diuretics as a class of traditional antihypertensive drugs, in recent years, clinical trials have shown that diuretics can not only control blood pressure well, but also reduce the morbidity and mortality of cardiovascular diseases and strokes. Therefore, diuretics are still used as the first-line antihypertensive drugs in the treatment of hypertension in the elderly. Diuretics were introduced relatively early and have long been unpatented, and can be produced by any pharmaceutical company. Its manufacturing cost is also relatively low, so the price is very cheap, and it is an inexpensive and good-quality antihypertensive drug. In the past, diuretics were applied in higher doses, so there were more adverse reactions. It can cause an increase in blood sugar, blood lipids and blood uric acid, as well as a decrease in blood potassium, so some people do not like to apply it. Later, some people conducted a study, if the dose is reduced, these adverse reactions can be greatly reduced or alleviated, or even disappear. Now we commonly use hydrochlorothiazide (we often call it dihydrochlorothiazide or DCT), as long as the dose is reduced to less than 25 mg/day, adverse reactions are rare. In the elderly, single diuretic therapy can also achieve satisfactory antihypertensive effect, but it needs 12~14 weeks after treatment to reach steady-state blood pressure reduction level. The recommended dose of diuretics alone is 12.5 mg/day of hydrochlorothiazide. Diuretics can be combined with almost all other types of antihypertensive drugs, and the antihypertensive effect is enhanced. Most patients with hypertension often need more than two antihypertensive drugs to bring their blood pressure to normal, and then diuretics are needed. The United States requires the use of diuretics whenever two or more antihypertensive drugs are used. So diuretics are not only the first choice of antihypertensive drugs, but also can be said to be the basic antihypertensive drugs. Diuretics and ACE-I and ARB have complementary effects, and the addition of diuretics to ACE-I and ARB can significantly improve the antihypertensive effect. The combination of diuretics with other antihypertensive drugs can also achieve the desired antihypertensive effect. Simple systolic hypertension in the elderly is characterized by low renin, low sympathetic activity, high volume and high stroke volume. Therefore, the combination of thiazide diuretics and long-acting dihydropyridine calcium antagonists (diphenhydramine) is more effective in the treatment. In recent years, a large international clinical trial of hypertension treatment was completed, in which more than 20,000 patients with hypertension participated, divided into several groups, using diuretics and other new antihypertensive drugs respectively, over a period of about 5 years. The trial was not sponsored by a pharmaceutical company, but was paid for by the National Institutes of Health Research in the United States, so it was not biased by commercial interests and was scientifically sound. Papers have been published in prestigious international medical journals as well as academic conferences. The results of the trial show that diuretics are as effective as other antihypertensive drugs when measured in terms of preventing or reducing complications of hypertension, and that diuretics are no less effective than other antihypertensive drugs. Although the United States is a developed country with a high per capita income, hypertension is a common and frequent disease. Primary hypertension requires long-term or even lifelong medication, which is also a heavy burden for a developed country like the United States. The aim of current antihypertensive drugs for hypertension is not to cure hypertension, but to lower it strongly and reduce its complications. Since clinical trials have demonstrated that diuretics are as effective as other new antihypertensive drugs in reducing complications, and new antihypertensive drugs are expensive, why not first consider the application of inexpensive diuretics? That is why the US guidelines for the treatment of hypertension (JNC-7) specifically emphasize that the application of diuretics should be considered first. If there is a contraindication to diuretics, other antihypertensive drugs are used. This provision is based on scientific evidence, not on the claims of individuals or individual experts. There are about 80 million elderly hypertensive patients in China, and China is a developing country, the per capita income of the elderly is still relatively low, the cost of basic social health insurance is still far from meeting the needs, since large-scale clinical trials have confirmed that diuretics are as effective as other new antihypertensive drugs in reducing the complications of hypertension. All the more reason to first consider the application of inexpensive and cost-effective diuretics. The current situation of hypertension treatment in China, on the one hand, is that many patients do not treat it, which has many reasons, but the economic burden of long-term medication is too heavy, is also an important reason. On the other hand, as soon as a patient has hypertension, doctors give new antihypertensive drugs, expensive drugs, which is a heavy burden for the country, and often a major reason for patients to stop taking the drugs. To make the treatment rate of hypertension higher and to make every hypertensive patient take medication, it is necessary to promote the application of diuretics to be considered first. This will benefit both the country and the patient. Types of diuretics Thiazide:It is the most used variety of diuretics, and the main one applied in China is hydrochlorothiazide (also known as dihydrochlorothiazide DCT) for the treatment of hypertension in the elderly with a commonly used dose of 6.25-12.5 mg. Flap diuretics:Furosemide, also known as tachyphylaxis, has a very strong diuretic effect. When renal function is severely impaired, hydrochlorothiazide cannot be used at this time and furosemide must be used. Furosemide is also needed when hypertension is combined with heart failure. Indapamide: This drug was developed and produced by the French pharmaceutical company Schweizer in the 1970s. China’s first production is Tianjin Lisheng Pharmaceutical Factory, the trade name is ‘Shoubishan’, the 80s began to apply. Now there are many pharmaceutical companies producing the drug with different trade names. The drug has a long duration of action and can last for more than 24 hours. So just take it once a day after breakfast. The dose used to be 2.5 mg. Now after research it has been found that it is sufficient to apply only 0.625-1. 5 mg. Amiloride:It is a potassium-preserving diuretic. It has a longer duration of action and only needs to be taken once a day. It is not used alone in the treatment of hypertension and is often applied together with thiazide diuretics. There are compound tablets combined with hydrochlorothiazide together, called compound amiloride. Spironolactone:Also known as Amiloride. It is an aldosterone antagonist and a potassium conserving diuretic. It is generally used together with potassium-depleting diuretics for the treatment of senile intractable hypertension or hypertension combined with heart failure. It is also used for the medical treatment and diagnosis of primary aldosteronism in secondary hypertension.