What are the side effects of diuretics?

There is more than one type of diuretic, and the side effects of diuretics vary due to their different diuretic principles. Diuretics can lower blood pressure and cause dehydration. They can also cause hypokalemia. Patients with hypokalemia should eat more foods containing potassium. Patients should pay attention to their blood potassium when using diuretics. It is recommended to take diuretics in the morning. It is best not to take them at night, otherwise it may affect sleep. Observe the urine volume after using diuretics.

1. Diuretic "cardiotoxicity"

In 1987, Kaplan, a famous American cardiologist, and others believed that hydrochlorothiazide could not reduce the incidence of myocardial infarction, which might be due to "cardiotoxicity" and lipid metabolism disorders. Multiple risk factor intervention trials in the United States have found that the incidence of sudden death in hypertensive patients with abnormal electrocardiograms increases after using diuretics. Framingham's epidemiological observation in 1988 also reported that diuretic treatment of hypertension increases the risk of sudden death. However, some scholars, after evaluating and studying the data from multiple reports, believe that thiazide diuretics do not increase the incidence of ventricular arrhythmias regardless of the presence or absence of hypokalemia.

2. Hypokalemia

Various diuretics reduce blood potassium by about 0.5mmol/L. Some patients can maintain blood potassium within the normal range, but 10-15% of patients can drop their blood potassium to less than 3.5mmol/L. Some patients may have normal blood potassium, but their entire body is in a state of potassium deficiency. Potassium may enter cells during stress response and cause hypokalemia, which may increase the risk of malignant ventricular arrhythmias caused by myocardial ischemia due to stress response. Among various diuretics, thiazide diuretics and furosemide cause more obvious hypokalemia, and long-acting thiazide diuretics (such as chlorthalidone) are more obvious than medium-acting hydrochlorothiazide. The hypokalemia caused by hydrochlorothiazide is related to the dose. The higher the dose, the higher the incidence of hypokalemia. If sodium is restricted moderately (60-80 mEg/day), potassium loss is minimal. However, hypernatremia or excessive sodium restriction can lead to obvious hypokalemia. Therefore, potassium-sparing diuretics or appropriate potassium supplements can be added during application.

3. Sugar metabolism

Some studies have shown that hydrochlorothiazide can increase fasting blood sugar, decrease glucose tolerance and increase insulin resistance in patients with hypertension.

4. Lipid metabolism

Most reports show that long-term use of hydrochlorothiazide can cause fat metabolism disorders, mainly affecting the activity of lipase, reducing triglyceride catabolism and increasing triglycerides; it can also cause a mild increase in cholesterol.