What are the different diuretics for high blood pressure, and what do they do?
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
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:
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.
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.
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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:
- 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
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:
Other side effects include:
- 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
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:
- loss of consciousness or coma
- extreme drowsiness or confusion
- irregular heartbeat or heart palpitations
- low blood pressure
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
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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- Arumugham VB, et al. (2022). Therapeutic uses of diuretic Agents. https://www.ncbi.nlm.nih.gov/books/NBK557838/#article-20623.s5
- Burnier M, et al. (2019). Redefining diuretics use in hypertension: Why select a thiazide-like diuretic? https://journals.lww.com/jhypertension/Fulltext/2019/08000/Redefining_diuretics_use_in_hypertension__why.6.aspx
- Huxel C, et al. (2022). Loop diuretics. https://www.ncbi.nlm.nih.gov/books/NBK546656/
- Khalil H. (2022). Antihypertensive medications. https://www.ncbi.nlm.nih.gov/books/NBK554579/
- Blood pressure medicines. (2021). https://medlineplus.gov/bloodpressuremedicines.html