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What are the different diuretics for high blood pressure, and what do they do?

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Types of diureticsSide effectsMissing a doseNatural diureticsSeeking helpSummary
Diuretics draw extra water, salt, and other electrolytes from blood vessels. This process can lower blood pressure, making diuretics an option for treating hypertension.
Medically reviewed by Alisha D. Sellers, BS Pharmacy, PharmD
Updated on April 26, 2023

High blood pressure, or hypertension, is a leading cause of cardiovascular disease and can contribute to diabetes and stroke.

In many cases, diet changes and regular exercise can reduce blood pressure without medication. However, if lifestyle modifications are insufficient, doctors may recommend antihypertensive medications, including diuretics.

Diuretics are not suitable in all cases. The Journal of Hypertension states people of African descent, older adults, and people with certain medical conditions may be especially responsive to diuretics. These medical conditions include:

This article details the different types of diuretics, their uses, and their side effects.

Types of diuretics

Overhead view of a person taking medicines in hand with a glass of water at home.
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There are several classifications of diuretics. 

Thiazide and thiazide-like diuretics

Doctors often prescribe thiazide and thiazide-like diuretics as first-line treatment for high blood pressure. Your doctor may prescribe them alone or combined in pill form with another antihypertensive medication.

Hydrochlorothiazide is a thiazide diuretic. It is a common option for treating high blood pressure. 

However, a review by the Journal of Hypertension states hydrochlorothiazide may not work as well as thiazide-like diuretics.

Thiazide-like diuretics include:

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Loop diuretics

Loop diuretics are more effective than thiazides in people with certain kidney conditions but are not a first-line treatment for high blood pressure in most cases.  

Potassium-sparing diuretics

Like all diuretics, potassium-sparing diuretics pull excess water and salt out of your bloodstream. However, they do not pull as much potassium out as the other types of diuretics, so they are helpful for people with low potassium.

Potassium-sparing diuretics, also known as mineralocorticoid receptor antagonists, are not usually used as first-line treatment for high blood pressure.

However, spironolactone (Aldactone) and eplerenone (Inspra) work well with other medications to treat high blood pressure resistant to other therapies.

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Side effects of diuretics

As with all medication, diuretics have side effects. 

Since they pull excess water and salt out of your bloodstream, frequent urination is a common side effect of all diuretics. Other side effects include:

  • fainting 
  • dizziness
  • headache
  • upset stomach

Thiazide and thiazide-like diuretic symptoms

Thiazide and thiazide-like diuretics may also cause:

  • low potassium, sodium, and magnesium levels
  • high uric acid levels, which can cause gout
  • high cholesterol 
  • high blood sugar
  • sexual difficulties
  • sleep disturbances
  • metabolic acidosis
  • dehydration

Chlorthalidone may cause severely low potassium levels in older adults and increase the chance of hospitalization

Loop diuretic symptoms

Loop diuretics can cause low levels of: 

  • potassium
  • sodium
  • magnesium
  • chloride

Other side effects include:

  • dehydration
  • high cholesterol
  • high uric acid levels
  • hearing problems or deafness

Potassium-sparing diuretic symptoms

While other diuretics can cause low potassium, potassium-sparing diuretics can cause severely high potassium levels in your blood. Other symptoms include:

  • high chloride levels
  • metabolic acidosis
  • dehydration

Missing a dose or taking too much

If you miss a diuretic dose, take it as soon as you remember. However, if your next dose is due soon, skip the missed dose and take the one due. Do not double up on the medication dose to catch up.

If you take too much of your diuretic, call your doctor. They may recommend you call poison control, come into the office, or go to an urgent care or emergency room.

Go to the hospital if you or someone near you experiences:

  • fainting
  • loss of consciousness or coma
  • extreme drowsiness or confusion
  • irregular heartbeat or heart palpitations
  • low blood pressure
  • seizures

Are there any OTC or natural diuretics?

Several foods and supplements seem to have diuretic effects. For example, people claim coffee, teas, and dandelion root extract, among other things, produce a diuretic effect.

However, more research is needed regarding the safety and efficacy of using these natural diuretics to treat high blood pressure.

Talk with your doctor before starting any herb or supplement. Bring a complete list of your medical conditions and the medications you take to show your doctor. Some herbs and supplements can interfere with your prescribed medications and worsen your situation.

When to contact a doctor

Diuretics pull extra water and some electrolytes from your bloodstream, which lowers your blood pressure. As a result, they can be very effective high blood pressure treatments. Your doctor may prescribe a diuretic by itself or in combination with other medications.

If diuretics alone do not work, your doctor may prescribe other antihypertensive medication, such as:

  • Calcium channel blockers
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin II receptor blockers (ARBs)

Talk with your doctor about what blood pressure medications are the best treatment option for you.

Contacting a doctor due to diuretic side effects

Contact your doctor if you experience any of the following when taking diuretics:

  • dizziness or weakness
  • feeling thirsty or having a dry mouth that is not relieved by water
  • fever or severe rash
  • frequent urination with very pale, almost clear urine
  • muscle cramps, weakness, or twitching
  • nausea and vomiting
  • yellow skin or yellow tint to your vision
  • sudden vision changes or eye pain
  • problems breathing
  • tingling or numbness in hands, arms, legs, or feet
  • gout

Summary

Diuretics are a class of medications that draw water, salt, and electrolytes from the blood. They reduce the overall blood volume and are a common treatment option for hypertension.

Many different types of diuretics are suitable for different instances. Speaking with a medical professional can help determine whether diuretics are necessary and, if so, which ones suit your symptoms.

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