Diuretics

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Hypertension therapy suggests wide use of diuretics, including thiazide diuretics, drugs related to them, such as metolazone (21.3.20) and indapamide (21.3.26), furosemide (21.4.11), loop diuretics, as well as potassium sparing diuretics—spironolactone (21.5.8), triamterene (21.5.13), and amyloride (21.5.18).

The molecular mechanism of diuretics acting as antihypertensive agents is not completely clear; however, use of diuretics causes a significant increase in the amount of water and electrolytes excreted in urine, which leads to a reduction in the volume of extracellular fluid and plasma. This in turn leads to a reduction of cardiac output, which is the main parameter responsible for a drop in arterial blood pressure and venous blood return. Cardiac output is gradually restored, but the hypotensive effect remains, possibly because of the reduced peripheral resistance of vessels. It is also possible that diuretics somehow lower vascular activity of noradrenaline and other factors of pressure in the organism. Methods of synthesizing thiazide diuretics used for hypertension are described in the preceding chapter, Chapter 21.

22.1.1 Thiazide diuretics

The most widely used thiazide diuretics are chlorothiazide (21.3.3), hydrochlorothiazide (21.3.4), bendroflumethiazide (21.3.6), polythiazide (21.3.8), hydrofluthiazide (21.3.9), trichlorometazide (21.3.10), methylcycloothiazide (21.3.11), cyclothiazide (21.3.12), and benzthiazide (21.3.13).

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